# I'm starting CBT...how do I get it to work for me?



## kerosene (Oct 26, 2010)

I have a really positive attitude right now for this and I don't want it to end.
I started CBT for anxiety but I'm not sure how the approach will work...I only had 2 sessions so far and we just talked about factors that cause me anxiety. Ummmm I don't know what else to bring up? I haven't had much talking therapy so I don't know how to work with her. Obviously I am sort of withdrawn and don't know what to say in general. Has anyone else had CBT, what did you talk about, how does it proceed?


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## wxolue (Nov 26, 2008)

First of all, I'm curious what you think of what you've heard so far.

I can tell you right now that the biggest thing you can do is to keep an open mind. Looking back when I started CBT, I really didn't know anything about my anxiety at all compared to what I know now after I did CBT. I learned things I never would have imagined as I went through...things I WOULDN'T have learned if I didn't keep an open mind. As soon as you get stubborn about what you THINK you know about your anxiety, you lose. Most of the new stuff you will learn is noticing thoughts you never noticed before, learning that a particular thought is actually negative, and is therefore perpetuating your anxiety, and learning that something you're doing is actually an avoidance behavior, and is thus perpetuating your anxiety.

Second, you have to stay motivated. CBT isn't easy, but you definitely get out what you put into it.

The last part is important. Because we have SA, when we enter therapy we will sooner or later (probably sooner) come up against some thoughts.

"This therapy won't work for me."
"My therapist doesn't get me."
"I'm not making any progress. I'm hopeless."

Not only are these the same thoughts that perpetuate anxiety, but they make the very therapy that could help you the enemy. I assume your therapist already told you that it's negative thoughts that create anxiety. Prepare for negative thoughts that target the therapy itself. Be ready for them.

Also I forgot to add that you shouldn't adopt a perfectionist attitude. Don't think you have to do every assignment perfectly, and don't think that failing to do an assignment means you fail CBT. If you do miss an assignment, TELL YOUR THERAPIST. This last one hurt me big time. Be completely open with your therapist. There's noway in hell they'll get angry or think negatively if you miss an assignment, even if you don't have an excuse. Always maintain good communication with your therapist. Important.



So there's my perspective on things you should know before starting. It is a personal perspective, based only on my own experiences, so take from it what you'd like.



I had group CBT therapy. I think it's very similar to regular CBT, except you don't get personal attention, and the therapy isn't really tailored to you. In my therapy group, here's how it went.

-Spent the first class introducing ourselves.
-Spent the next few classes talking about what causes anxiety, and the two aspects of CBT: Cognitive Therapy and Behavioral Therapy.
-Started doing exposure therapies. This involved doing "public speaking" in front of our group. These exercises are intended to evoke anxiety. In order to keep pace with the success of behavioral therapy, they added conditions to our speeches to make them more difficult (discussing a sensitive topic like gay marriage, wearing a funny hat, taking questions at the end, stating an obviously incorrect fact as if you believed it, etc). In this sense, each week we experienced the same amount of anxiety, even though the exposures would be getting harder and harder.
-We also started doing assignments for the cognitive therapy. This involved trying to recognize negative thoughts we come up against during the week, and attack their credibility. We had a sheet we would go through with each thought (4 thoughts a week were required).
-After a few weeks of the in house exposures, we went outside the therapy room and did other exposures. These exposures could be anything, as long as they evoked anxiety. Here are a few we did in the group:

-Ask a random group of people if you can practice a wedding speech on them. If they say yes, you must then perform a speech without any preparation about an imaginary wedding (obviously you're supposed to make them believe it's real).
-Purchase condoms at a store, start counting out from a jar of coins, realize you don't have enough, and then say never mind. Leave without purchasing anything.
-Initiate a conversation with someone of the opposite sex (or same sex if you're gay) and hold the conversation for 5 minutes. At the end, ask for his/her number.
-Dancing/singing to a song on your ipod in public.

Obviously you won't do any of these on your first day, or ever depending on your therapist. You'll be designing exposures to be like stepping stones. Start out small and keep making them harder and harder.

-After a few more weeks of that, we started getting exposure assignments to do between therapy sessions.

Thats my experience in a nutshell. Don't hesitate to ask any questions.


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## MrShyAndTimid (Jun 28, 2010)

@wxolue - Nicely put. I cannot agree more with what you've posted. Nicely done.

@kerosene - Just don't get discouraged. Everything is a learning process. I have my struggles and I have my phases, like the ones mentioned below. I had my weeks where I felt I learned a great deal and it carried on into the following week and into the other week, then all of a sudden I hit a wall. My thoughts have turned stubborn, but I've tried to keep going and that's the main sticking point. You just have to be consistent, persistent, and take in everything (success and failure).


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## kerosene (Oct 26, 2010)

Wow, thanks for so much info. I didn't know what to expect but it does sound like the kind of therapy I am looking for, I had a lot of "passive" talking therapy and it didn't seem to do much, I guess. I feel like I already know the cause of the problems but I don't know what to do about the anxiety itself so I'm looking for a direction on that. I hope I get a lot of assignments/someone making me "practice" so I guess, I am feeling motivation to do better. The assignments you mentioned sound really hard, I can't even imagine doing some lol. Ok, ALL of the public ones make my head explode. But, it would be neat if I gradually could. I'll try really hard to keep an open mind...


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## wxolue (Nov 26, 2008)

I agree with MrShyAndTimid. Sometimes the most challenging part about CBT isn't surviving the anxiety at all, but responding after the fact. Its important to learn how to accept your success when they happen, and understand that failures are only temporary; learn that a bad day only has to be one bad day. Remember your successes, because those will help you bounce back from some bad times.

As far as causes of anxiety, here's where I stand. Part of me thinks I know where my anxiety came from. Part of me thinks there could be other sources I don't know about. Most of me however doesn't give a crap. I'm not holding onto my past, so why should my therapy? I have anxiety now and I'm ready to change that. It really doesn't matter what happened before.

I like your motivation. That is exactly the kind of ambition you need to go through CBT successfully. However, make sure you stay flexible. Therapy is an opportunity to better yourself as a person, not a one stop track to complete confidence. My first round of CBT wasn't the panacea I hoped it would be, and I became depressed after it didn't completely cure my anxiety. I took it out on myself. I was blind to my successes during the therapy, and to the problems I came up against that interfered with my ultimate goal; problems that were out of my control. It took me a while to accept that there were problems with the therapy center, not with me. I finally realized that my expectations were unrealistic. I'm ready to look for a new therapist, and keep doing CBT until it sticks.

I hope I didn't scare you with my examples haha. There's no way anyone forces you to do exposures if you're not comfortable. Exposures feel different than regular anxiety somehow. When I go into normal anxiety provoking situations, the feeling of dread and the need to escape is momentous. When I was doing exposures, it was still the same anxiety, but it was empowering rather than defeating. I wasn't trying to bury the anxiety, but trying to really feel it. It was enthralling and uplifting, and the feeling of elation I felt after a successful exposure was awesome.


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## shyguy26 (Jan 15, 2011)

Wow, just wow. I once went to a psychologist and I don't know why it didn't really work. In fact the therapy session not at all structured like yours. I hope I would be able to find a good therapy group like yours in the next few years. By the way, how long was the CBT? Was it just 12 weeks or more?
--------------------------------------------
Edit - Oh and hope CBT works great for you Kerosene!


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## wxolue (Nov 26, 2008)

Mine was 12 weeks. I think 12 weeks is fairly typical for CBT.


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## shyguy26 (Jan 15, 2011)

wxolue said:


> Mine was 12 weeks. I think 12 weeks is fairly typical for CBT.


And you progress that much in 12 weeks? 
How did you guys manage that?

The meetup group we had where I live is not there any more and any chance of working in groups is pretty much non-existent. I guess I have to wait until I move to a bigger city.


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## wxolue (Nov 26, 2008)

When I look back on it, I guess I did make a lot of progress while I was in it. I've gone a bit backwards since then, for a number of reasons, but im aching to start doing therapy again.

I would actually prefer doing it one on one. It allows for more personalization of the therapy, something my group therapy lacked. You also get less attention in a group.


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## nonethemore (Oct 18, 2010)

wxolue said:


> ...the feeling of elation I felt after a successful exposure was awesome.


There is nothing quite like successful exposure, probably one of the best feelings in the world  I felt on top of the world after each one. I'll probably write more on CBT later, too tired right now.


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## robtyl (Sep 2, 2010)

Wow, nice post wxolue! I'm starting therapy soon too, and I'm glad to have read your post. I desperately want it to work, but was worried about these pessimistic thoughts about it not working - and I can imagine myself developing feelings that it isn't working, etc...


To others: Please post about your experiences too! It's difficult to wrap your head around for someone who hasn't done it before.


Much appreciated guys 


x


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## shyguy26 (Jan 15, 2011)

wxolue said:


> It allows for more personalization of the therapy, something my group therapy lacked. You also get less attention in a group.


Well my one to one therapy certainly didn't work for me. I am not sure if my therapist was using CBT or if she had any experience with it. Maybe I need to find a new therapist.


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## wxolue (Nov 26, 2008)

It's all about personal preference. If you think group therapy would be something you would benefit from, go for it. Don't let my experiences change your mind.

Noone can help you do an exposure. That's all up to you. However I ALWAYS found it helpful to have an exterior perspective on my negative thoughts. This allowed me to learn that a certain thought was negative, which never would have happened on my own.

If you wouldn't mind robtyl, your fear of pessimistic thoughts stopping your therapy from working is in itself a negative thought! This is a perfect opportunity for you to stop this line of thinking. Reason with yourself, If you're aware of the possibility of negative thoughts, its highly unlikely that they'll ruin your therapy undetected.


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## AlekParker (Oct 31, 2006)

how did you find that therapy group? I'm looking for one right now, (also for a personal therapist). How do you find it? just through your insurance or google search?

I want to get an experienced one that is good with SA, I fear wasting months on a crappy doctor or ineffective program. Also money is a big factor for me and my insurance is an HMO :afr


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## nonethemore (Oct 18, 2010)

.


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## AlekParker (Oct 31, 2006)

Thanks Nonethemore. That was VERY helpful. especially what you said about the importance of exposures and to ladder them upward to more anxious ones.

I think I've been to the websites that list psychologists in my area etc. I kind of wanted to get recommendations from other people with SAD in my area because it seems like a lot of doctors/therapists don't fully understand SA. I don't want to waste my time/money with the wrong one.

Maybe I'm over thinking this and being a perfectionist which might actually get me to not ever get help.... hmmm.... i might have to just choose one on the list, but I'll continue my search for just a little longer thanks:idea


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## nonethemore (Oct 18, 2010)

AlekParker said:


> Thanks Nonethemore. That was VERY helpful. especially what you said about the importance of exposures and to ladder them upward to more anxious ones.
> 
> I think I've been to the websites that list psychologists in my area etc. I kind of wanted to get recommendations from other people with SAD in my area because it seems like a lot of doctors/therapists don't fully understand SA. I don't want to waste my time/money with the wrong one.
> 
> Maybe I'm over thinking this and being a perfectionist which might actually get me to not ever get help.... hmmm.... i might have to just choose one on the list, but I'll continue my search for just a little longer thanks:idea


No Problem Alek  I understand your concern about finding the right psychologist, maybe you can choose a few of them to contact and ask them about what method they use (CBT, psychoanalysis, etc), what they specialise in, what they charge, discounts, etc. Then go from there.

If any Australian is reading this, the link I posted above actually lets you specify what problems you want to address in therapy and whether or not you want a medicare-supported service. It's pretty handy.


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## wxolue (Nov 26, 2008)

If your belief that therapists don't understand anxiety stems from people on these forums I would advise you to take it with a grain of salt. Remember that psychologists have to get their phd studying mental illnesses. Anxiety is the third most popular mental illness. Chances are they know more about curing anxiety than some of the people who claim they know nothing.

With that said, nothing says you have to keep studying past grad school. Therapists, especially older ones, may be behind the times with their information.

I agree with what nonethemore said. It would be worth your while to see what types of therapies they use. Do a google search on their name. There are many sites out there that allow people to publicly review and comment on businesses and services such as plumbers, therapists, etc. Do your research, but don't walk in the door with assumptions in your head about how much they know.


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