# RESOURCE: A CBT Process Outline (followable)



## yeah_yeah_yeah (Mar 27, 2007)

This is in reply to a common question about CBT from another thread. Though I would repost as it has a lot of the material I was going to cover anyway.



> Um I was curious does cbt by dr. richards apply to all cases of social anxiety meaning like the severity because I heard that some people cant even leave their homes


Its not that clear cut, and it depends how hard the person can work at using the tools. here comes one of my long "how to" type posts with instructions on how to follow the most important elements of CBT for SA. Say again - this is an outline of how to use CBT to help you overcome SA symtpoms in social situations.

IMO, the Dr Richards tapes, at roughly $300, are beaten hands down by the book "Overcoming Social Anxiety and Shyness" (of which I present some key aspects below) which is both more up to date in terms of SA research and $280 cheaper. The tapes may feel like less work because you think you can just sit and listen, but you still have to apply it. IMO getting this from a book at the fraction of the cost seems like an easy choice.

The speed of progress of any CBT approach will be dependent on the current severity of symtpoms and the amount that the person works to overcome it. For example, you will construct a list of all the things that SA prevents you from doing, If the current hardest thing in the world for you to do is just go to the grocery store, but one day you would like to date, then it will take you longer to get to the final 'success' of dating than if your current hardest thing is say, going to a bar. Its like a sliding scale.

First you use the paperwork - the cognitive / thinking skills - to WEAKEN your beliefs and to present some ammunition against them. You need enough ammo to be able to have a little more confiednece for the next stage, which is TESTING IT IN THE REAL WORLD. A lot of people think that CBT for SA is just about sitting down and writing and that then everything magically changes. This is wrong. Reality testing, or behavioural experiements as they are called, are the other 65% of the therapy.

[center:325nrvt3]*Cognitive*[/center:325nrvt3]

If your current belief is "people always laugh at me when I blush", then the cognitive part might go like this:


1) How often do I blush? 100% of the time? How visible is it to others? Am I like London Bus or more pinkish like a little tree blossom?

2) Do 100% of people really care if I blush? Have I seen other people blush and not been botherd by it? Have I ever seen people blush in front of others and it has been ignored?

3) Why does it matter if people laugh at me? What is the worst thing that might happen if they do laugh? Will they tell the whole world and produce a billboard saying "Ross blushes! Kill him! Ostracise him! What a wimp!". How likely is this to come true, on a scale of 1-100%?

4) If I laughed at them, would I expect them to feel as unhappy as I do? Do some people seem to get laughed at and not be bothered by it? What might they know or feel that means they do not feel sad, where I do?

5) "No one blushes like I do". Really? How can you be sure? Is it possible that as in the question above, you overestimate how red you go, and maybe you bliush only as much as you see others do, but discount it because you FEEL you go much much redder?

6) People always scowl at me. Sometimes some people are rude enough to do this, but generally most people are non-judgemental. However, when we are feeling anxious, our feelings tend to make even small facial cues look very threatening. Try to notice qwhen you are already feeling anxious and how this affects how you respond to people and vice versa. Ask - did I really interpret that right? Maybe they are having a bad day. Maybe they have a miserable face. Maybe they have just been bawled out by their boss. Maybe they are worried about a date tonight?

To further dig into beliefs there are many many techniques such as 'The feared fantasy', the 'Double Standard Method', Socratic techniques, Devils Advocate and so on. You can find a hige collection of these in David Burns "When Panic Attacks".

Again at this stage, the aim is only to WEAKEN the beliefs. You may 'get it intellectually' but not 'at your gut'. Thats what the next stage is for ....

[center:325nrvt3]*Behavioural*[/center:325nrvt3]

1.Safety behaviours

First you need to identify *saftey behaviours*. These will be things you do that you *feel *keep you safe. In the example of blushing, a good friend of mine used to wear a big floppy hat and extra make up to cover it. She found that when she stopped using these and paid attention to her surroundings more, she could see that people just get on with things and barely notice. Is there anything you do to 'keep safe' from your worst fears? You need to drop them before you go onto the last stage. The reason for this is simple - if you believe you are keeping safe with something, then even when there is no threat you attribute this to the "safe keeping" practice, and never get a chance to see that in fact, there is no threat or that the threat is much smaller than imagined. Its a bit like saying "Garlic stops vampires coming down the chimney, and the proof of this is that no vampires have ever come down my chimney which has garlic hanging by it". An overganeralisation, yes, but you get the idea! What you are aiming for is giving yourself the BEST CHANCE IN THE WORLD of actually seeing that your most feared outcome very rarely, if ever, happens. Saftey behaviours and internal processing ( a unique aspect of SA) stop you from processing evidence that disproves your fears.

2. External Awareness:

Go  HERE  and do the exercise attached there. This will prevent the above mentioned 'internal processing' from kicking in and colouring how you see the world through your feelings.

3. Experiments

Now that you have some weapons in your arsenal, you are ready to try your first experiment. *Before you begin * YOU MUST sit down and write out EXACTLY WHAT YOU FEAR WILL HAPPEN. For example:


_Belief:_ I blush so much that people look down on me. I belive this ____% (1-100)

_Experiment:_ Go to the store and buy something, dropping my safety behaviours such as wearing a hat, or make up (for the girls), planning what to say in my head all the time and not listening, leaning against things, gripping things tightly, not speaking at all or speaking in clipped tones etc
[hr:325nrvt3][/hr:325nrvt3]
_Feared outcome:_ I will blush. People will look at me disapprovingly. I will feel awful. They will be thinking how weak and pathetic I am.

_Evidence to look for that shows my fears have come true:_ People scowling at me. How can I know for 100% sure what they are thinking? Im not actually psychic, so I'd have to guess based on my feelings and what I interpret from their faces. Am I clairvoyant? Or is it possible that sometimes I actually read peoples faces based on how anxious I'm feeling at the time?

_Actual outcome:_ Write what happened.

New strength in above belief ____% (1-100) .
[hr:325nrvt3][/hr:325nrvt3]
In the blushing scenario, you may wish to go to a local store, or if you prefer, one out of town. Your experiment will be to buy something at the checkout, without using safety behaviours or compensations. Just go straight through.

When you write down your strength in the new belief, observe the change. If it is only small, then you will probably need to repeat the experiment again, perhaps in another store so that you get a good 'sample size'. The aim is to repeat it until the feelings of anxiety drop to a level where you are comfy, or as very often happens - until they disappear completely!

Anxiety Ladders

Basically, create a list of all the things you want to do but cannot. Start at the easiest and work your way up it, using the above tools. A tough part can be coming up with good experiments to do - but this is where the therapy becomes 'personalised' - you direct it and control it. In the case of those that cannot leave their homes, then a first experiment might simply be to look out of the window, or step into the porch or the front garden. It may be useful to relax or meditate first after having done the cognitive and pre-experimental work. Then maybe decide "I am going to go out into my garden and look at the lawn". There is then a reason to be there, but at the same time the aim would be to look up every now and then to keep the external focus going. *Agoraphobia is hugely dependent on internal processing so the attentional training is very core for these people.*

If you go to my post  HERE  you will find even more CBT tools to use in your journey.

Ross


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## CopadoMexicano (Aug 21, 2004)

wow, thanks a lot for the information im afraid i might have the symptoms of agoraphobia or a residual of trying to leave the house feeling safe


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## StimulateYourBrain (Nov 20, 2011)

amazing


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