# RESOURCE: My Psych Routine and CBT Process Overview



## yeah_yeah_yeah (Mar 27, 2007)

Hi there

A few people have asked me what my approach to overcomind depression and anxiety is / was. This is how I summarised it for any folks who are interested. I have cut this from a PM I sent someone

Hi dude

Hehe you have just brought a VLP on yourself. (Very Long Post ) In WORD this is a 4 page document! You might wanna cut and paste it into there so its more readable This is as comprehensive as I can make it, but won't even touch what you will get out of PROPERLY using and reading a good CBT book. The ultimate is a CBT trained therapist you like and trust. Personally I would avoid any ex-freudian psychoanalysts as they are just odd.

Ok so routine ... I have a big toolkit of things that I use, and find myself trying out all different ways of tackling a problem. If one fails, I try another. However, a basic starting out CBT routine, and the one that forms the backbone of what I do, looks like this:

1) Understand CBT theory as well as you can. Important step. Do it or the rest is kind of pointless. Read about the thought / feeling / behaviours connection. Understand the common thought distortions. Practice catching when your mood changes and try to isolate what thought was going through your head. At first this step alone is tough as you will have got used to them just flying through and you just feeling the result.

2) Begin using the mood diary. If you have done step (1) properly, you should have a good idea of how to fill the form in. Capture the situation (I was in a pub and a guy pushed me) the immediate emotions (angry, sad, depressed) and rate them before the diary. Capture your thoughts (He is trying to make me look small. He is such an a-hole! People always pick on me. I should stand up for myself. I am so weak). Capture verifiable evidence both for and against each thought you have captured. Evidence based only on your feelings is not evidence - you will find out about the EMOTIONAL REASONING error when you read. Find a rational alternative. There will be instructions how to do this and need to be personal to you. Keep arguing until you feel a shift. If you do not, rate how much the mood has changed and leave the sheet. Think about coming back to it in a few days, or ask someone else what they would do or think. Keep doing the mood diaries for about three weeks, trying to do one every day or at least when you feel bad.

3) With time you will build up a collection of forms. Study the automatic thoughts in each and try to spot any common themes e.g. I wish i could stand up for myself, or other people always victimize me. You may have seen that this is overgeneralization error, which is good - but you need to find the underlying root.

4) Using the mood diaries, find common themes. They will usually be in the form of assumptions (*If *I am not completely confident, *then* I will be rejected) or rules (In order to be liked I must be amusing). Challenge these with alternatives sheets. When you identify the assumptions and rules (eg If I look weak then I will be attacked; I will always be rejected) or beliefs (I am unlovable / repulsive - note the difference in form of the types.), you need to come up with a more useful or helpful alternative. This could be a little shift, like going from "I am repulsive" to "I am ok looking and some people think I look ok) then you need to set up what you are going to observe, preicting what will happen, and then go out and TEST. This is where behavioural experiments are absolutely key. IN SA, THE WAY YOU DO THE EXPERIMENTS - BOTH THE SET UP BEFORE, WHAT YOU DO DURING, AND WHAT YOU DO AFTER - are of the utmost importance. Get this wrong and your hard work will be for nothing. This is why I keep banging on, and on, and on about buying the books to people. You cannot 'wing' CBT. Not that I'm saying you do - its just a warning to be aware of. All of the guys I have PM'd on this site who have said CBT 'failed' for them either tried to wing it, didn't read properly, lied to their therapist, went only to two sessions, only tried the book briefly etc etc. It will not work like that. Once its done, feed the experiment back into the new belief you wrote and rate how much you now believe it. The idea is to encourage behaviors that force you to look at the other side of the coin.Create experiments to try them out.

5) Keep using mood diaries and think about your assumtions and the findings of your experiments. Now take a bit of paper. At the top, write something relevant, such as "If I do not come across 100% confident, I will be picked on". Beneath it write "what would it mean to me if this were true?". Answer the question, and keep asking it of each answer until you go as far as you can. Eg I am picked on > I cannot defend myself > people look down on me > I am unrespectable. Keep going until you unearth something that really means something to you. Really you need to READ about this in CBT books to really get the idea from examples. This may reveal an assumption or a core belief which will be like "I am unrespectable" or "I am worthless".

NB As you may see above, there are three levels of cognition - thoughts, assumptions and rules, beiliefs. Read about these different levels and what to do with them. You need to progress through each in order to get to your own core problem.

This is a rinse and repeat basic process for as many beliefs, rules and assumptions you can find. Even when you get to the latter stage, continue to use the mood diaries because they are your emotional brake. They will stop you ruminating and allow the mind to deal with what has upset it. The more often you spend OUT of feeling bad, the more time you spend feeling neutral or better - and this is the path of happiness.

OK so now you might be asking, why all the other exercises? Basically there are around 60 (actually more) pure CBT methods that you can use to help you cognitively or behaviorally challenge beliefs. There are whole books of behavioral experiments. But the purpose is always the same - to help you see the flipside of the coin and reinforce your new belief.

The process must be followed or you will not experience change. You need to be as regular as you can, but don't get a n a l over it, as obsessing can get you down just as much. On top of the pure CBT methods I also use compassion and emotions based approaches (see 'Reinventing your life'), mindfulness, focus control techniques (actually a standard part of CBT for SA now), meditation and building a life for myself. I read many books on philosophy and psychology. Please note however that I have been stuck on ONE belief for a very long time due to a break in therapy. I have finally cracked it by throwing everything I had in the cupboard at it and having an awesome therapist.

The role of a therapist in getting better cannot be overstated - it is an immense aid to recovery. Hold it in reserve after you have tried to go it alone but are possibly stuck - the books are very effective, and also if you get the hang of CBT before you see a therapist, you will save a load of cash on the 'learning' stage and can form a good partnership straight off. A CBT therapist does not 'cure' you - they are a buddy in helping YOU use CBT to tackle your problems.

I personally had good success with applying the ideas of Schema Therapy which helped me to crack the approval nut. It is a combination of CBT, Psychodynamic, Interpersonal and Attachment Theory and is very good at understanding how early life experiences can remain lodged in your head. The book for this is listed below.
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TIPS: 
a) Do not try to catch thoughts DURING unpleasant situations. Either do it before or after. Just let the situations happen and handle them as best you can.

b) Think about adding a PLAN column to your mood diary, or else identify in your journal what you might do to overcome certain deficits 0 if indeed they are REAL deficits. Saying "I am boring" is nearly always not true - the fact is anxiety stops you from being natural. So the aim is to try for naturalness. How to do this? Read Overcoming Shyness and Social Phobia by Donald Rapee. Read about external focus and eliminating safety behaviors. The Gillian Butler book also has this same information. These books are total GOLD for overcoming SA. Mindfulness is a useful tool here also.

c) If you are really really stuck, do not despair. If you cannot feel that deep emotional shift in a belief, it may be that you began learning it so early that it is totally buried. The vast majority of people, even though they believe they truly are the one hopeless case on this earth, find that they CAN help themselves - but in fact they just FEEL hopeless. Emotional Reasoning Central ... What you may need here is a more emotional way to handle the belief. Compassion Based CBT I found to be helpful here as it forces you to act from an emotional standpoint. 'Reinventing your life' (Schema Therapy) is also very very good.

d) Journal out any rants. If you have problems with anger, write a rant at someone. Once on paper its amazing how much better you feel, and the space it gives you is amazing.

e) Try telling people about your problems. You will be amazed how understanding they are, how non-judgmental they are, and how much your anxiety reduces when you do. Healing is about paradox - by and large you need to do the very opposite of the very thing your fear convinces you not to do.

You will see above how there are many options and roads you can go down, its a case of experimenting and finding what works for you. If you buy these books and read them again and again, and use them as reference each time you tackle a problem or get stuck, then you will have the equivalent of a nuclear arsenal against SA and depression. '*'s are essential, others are just awesome to have.

*Feeling Good - The New Mood Therapy - David Burns
Treatment of Anxiety Disorders - Clark and Wells (Technical text but amazing for understanding the disorders and latest research. Feeds well into ..
*Overcoming Social Anxiety and Shyness - Gillian Butler
Overcoming Shyness and Social Phobia - Donald Rapee
*When Panic Attacks - David Burns - huge resource of CBT exercises
The Feeling Good Handbook - David Burns - another huge resource - exercises and examples
*Reinventing Your life - Klosko - for the more emotional level. Very very good at pinpointing your precise underlying problems, though the guidance for SA type disorders is pretty much pure CBT with some added components. VERY ENLIGHTENING BOOK.
*Mind Over Mood - Greenberger and Padesky (BEST 'guided process' book out there)
Oxford Guide to Behavioural Experiments
Calming Your Anxious Mind (mindfulness) - or other Mindfulness title though this one good
*Compassion - Paul Gilbert

They will cost a fair amount of cash, but for me they have been what has got me out of this rut. The regular CBT process works for the vast majority of people - its just whether or not you can take on board the new belief at a gut level. My key was simply this - I was using CBT and everything else to try to make me into a social stud. When I realised I should be using it to build a life full of all different things and concentrate less on 'social success', I found i became happier. The social part handles itself after that.

Sorry that was long dude.

Ross


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## dkknight (Feb 24, 2008)

*Re: My Psych Routine*

Thanks for posting this. For a start I bought David Burns book, hopefully it will serve me as a daily guideline. I can't wait to pick it up at the post! I wanna break free of all this insecurities that I have. In the meanwhile I might start with the moods diary!


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## yeah_yeah_yeah (Mar 27, 2007)

*Re: My Psych Routine*

Just to add, this is an ongoing, daily thing. I use mood diaries all the time - but when you begin the mood diary alone will not get to the very root of your problems. It will help you see things realistically, and will soothe you, but it is a tool to get you somehwre deeper. You must follow the course, dig out those one or two most damaging beliefs you have, FEEL THE CHANGE at the gut level and then continue with the diaries.

Its undoing decades of damaging thinking - it takes time


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## tomcoldaba (Jul 1, 2007)

*Re: My Psych Routine*

Thanks for a great post.

You mentioned Schema therapy in your post but I cannot find it in the list of books. Maybe, I am missing the point.

Per your advice in August, I kept the mood diaries for month. It helped me immensely. I would ask a couple of my friends for their input. They saw the situation totally different from me. I was mind reading or overgeneralizing most of the time.

Now I journalize my maladaptive thoughts instead of the mood diary. My maladaptive thoughts occur infrequently. I am consistent with my exposure therapy. My anxiety is low.

Today, I had a long conversation with my boss about health issues. Dealing with people in authority made me nervous. Also, if there were silences in the conversation, I would panic. Not today, I just assumed the conversation needs a pause. Wrote my view of the conversation in my journal.


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## Zellkai (Nov 12, 2007)

*Re: My Psych Routine*

TERRIFIC post! I'm sure a lot of people can benefit from this, thanks for writing it.


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## beasty (Mar 3, 2004)

Reading your many posts it seems that its not only one thing that has helped you but rather a combination.
I am curious as to how meditation and the medication you get for the dysthymic-thing connects to your progress. I mean how important do you think those components are in your progress relative to the above technique? How important is that combination you think?
I ask because much of what you write about your progress is pretty similar to mine. The conclusions I mean. I use meditation exclusively, but meditation is kind of a crashcourse in CBT. If people are able to get better doing the things we do its probably pretty important that they replicate all of it not just bits and pieces.


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## nenad (Jan 3, 2008)

Thanks for the resource. I've started CBT and have found your threads to be very helpfull.


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## yeah_yeah_yeah (Mar 27, 2007)

Hi guys, glad its all useful to you! 

Beasty - for me CBT is the core, powerful pillar and everything else hangs off it and supplements it. Generally all the other additions I use to amplify the effect of the CBT, particularly when doing behavioural experiments. On medication ALONE I make little to no progress at all. I am on a maintenance dose of effexor because research shows that for dysthymia (which I had for 18 years) a combination of meds and therapy is the most powerful. However it was a breakthrough in therapy (CBT) that finally put paid to depression and anxiety - I literally felt it right there in the office like a bolt from the sky. I have posted it about it elsewhere.


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## yeah_yeah_yeah (Mar 27, 2007)

*Re: My Psych Routine*



tomcoldaba said:


> Thanks for a great post.
> 
> You mentioned Schema therapy in your post but I cannot find it in the list of books. Maybe, I am missing the point.
> 
> ...


Coooooool! :banana

Doing a whole month is excellent - as you saw, after that time the challenges that you make on paper start to creep into your everyday thought, and once you reinforce that (most important part) with a change in behaviour, thats when it really locks down!

Really great news Tom! 

Ross


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## beasty (Mar 3, 2004)

yeah_yeah_yeah said:


> Hi guys, glad its all useful to you!
> 
> Beasty - for me CBT is the core, powerful pillar and everything else hangs off it and supplements it. Generally all the other additions I use to amplify the effect of the CBT, particularly when doing behavioural experiments. On medication ALONE I make little to no progress at all. I am on a maintenance dose of effexor because research shows that for dysthymia (which I had for 18 years) a combination of meds and therapy is the most powerful. However it was a breakthrough in therapy (CBT) that finally put paid to depression and anxiety - I literally felt it right there in the office like a bolt from the sky. I have posted it about it elsewhere.


Roger that (;
Now time for some free joy. The sun is shining over here


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## raymac_6262 (Dec 31, 2007)

Again, your insight and understanding is brilliant. Thanks for sharing the information Ross.
Cheers,
Ray


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