# Is CBT the only way to cure SA?



## Ryukil (Jun 2, 2011)

If you think about it, CBT is the only way to solve SA that really makes that much sense.


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## Daktoria (Sep 21, 2010)

Well if SA happens because you think too much, sure. Excessive anticipation can leave you with a sense of emptiness or nothingness.

Anxiety is an emotion, though. It's something that you should take meds for until you live an organic lifestyle that can regulate your emotions.


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## Bohuw (Feb 1, 2013)

I agree with you slightly Daktoria, My view is that the emotions can be thrown off by imbalanced hormones. So If it's not a case of "thinking too much" the hormones need to be addressed not emotions. 

I think CBT is the best way to cure SA and it does take time becasue you are essentially reprogramming your brain and thought patters. In saying that, there are also many techniques of CBT some may work for you and some may not.


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## brunteca (Jan 17, 2013)

If CBT is the only way, I'm buggered.


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## Nivea (Feb 25, 2013)

Maybe


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## pbanco (Jan 13, 2013)

Ryukil said:


> If you think about it, CBT is the only way to solve SA that really makes that much sense.


I don't think CBT is the only way to solve SA. For one thing,
it makes no attempt to address the source of the anxiety.
Anxiety is a feeling state. It is possible to feel it's sources
and heal it. There are probably two general ways to deal with
anxiety. One is to try to push it down with coping mechanisms
or medications. In that case, if successful, it is still there but not emerging. The other way is to feel the sources of the anxiety and eliminate them entirely. This will also alleviate the related symptoms such as negative thoughts etc.


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## wanderer13 (Jan 13, 2012)

It indeed is pretty much the only way to cure SA.

All drugs treat the symptoms, not the source, so no matter how much paxil you take, sa will never be cured just from that.

Ofc there are many other techniques that will work, like acceptance etc, but i view them all as an alternative form of CBT. You can get "cured" by SA without doing any CBT, but just doing all the work yourself: Deconstructing false beliefs,stopping negative thoughts, taking small risks to gradually change your feelings and who you are......but guess what....even that is a form of CBT.

So yeah CBT is the way imo, and to anyone that feels that CBT "does not work", i'd urge them to try again, maybe in a different way, because cbt CAN NOT fail if you believe in it.


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## pbanco (Jan 13, 2013)

wanderer13 said:


> It indeed is pretty much the only way to cure SA.
> 
> All drugs treat the symptoms, not the source, so no matter how much paxil you take, sa will never be cured just from that.
> 
> ...


A good discussion might be about what the sources of anxiety are.
I don't mean social situations; those are just triggers for the anxiety to come
out. CBT simply teaches ways for the person to cope with anxiety, it
doesn't touch the source. But it does work for a lot of people and is the most
commonly found therapy around. The therapy I have used doesn't
focus at all on thoughts and beliefs, it instead concentrates on feelings.
That approach is much different than CBT and it has worked for me.
I looked at CBT, but rejected it. I thought my SA was too severe for
me to learn how to cope with it. What I wanted was kind of a complete
overhaul, not a coping mechanism.
By the way, you do need to have some belief in whatever therapy you
are trying, otherwise it has a poor chance of success. For that reason,
it's best to choose it yourself and understand what it is about , before
getting started.


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## Abeardsell (Feb 16, 2013)

SA comes from the strategies that we run in our mind. We literally programme our minds to become anxious in given circumstances. The programme in our mind then runs whenever we trigger it. So for example many people get anxious when they think about standing up in front of an audience. Just the thought of standing up in front of other people sets off the programme that gives them the anxiety.

So, yes CBT does help because it helps break down the thought process involved with running the programme.

NLP helps as well. You can see here a video demonstration of the NLP Shish Pattern which helps with changing disempowering mind patterns like anxiety.

http://excellenceassured.com/podcasts/nlp-swish-pattern-demo-video


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## pbanco (Jan 13, 2013)

Abeardsell said:


> SA comes from the strategies that we run in our mind. We literally programme our minds to become anxious in given circumstances. The programme in our mind then runs whenever we trigger it. So for example many people get anxious when they think about standing up in front of an audience. Just the thought of standing up in front of other people sets off the programme that gives them the anxiety.
> 
> So, yes CBT does help because it helps break down the thought process involved with running the programme.
> 
> ...


I don't think people program themselves to be anxious. Anxiety is a feeling
state and we don't program our feelings. What about people who experience
panic. That can be a very strong feeling rising up out of the body.
You can't program yourself to experience such a thing.
Look at PTSD. People with that often have anxiety as one the symptoms. War or sexual assault, for example, can cause PTSD. The person has been traumatized and certain situations reactivate the memories of the trauma which are still there repressed. It's the same for any anxiety. If you
have anxiety it means that at some point you were traumatized.
The solutions are to better repress traumatic memories with drugs
or therapy, or to release them with therapy. CBT is just a way to help repress traumatic memories.


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## Invisiblehandicap (Jul 31, 2011)

It depends on the person. For me, CBT is kind of like taking a panadol for a large wound. It helps, but then the anxiety just comes back. Exposure has worked much better to be honest.


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## Pam (Feb 14, 2009)

pbanco said:


> I don't think people program themselves to be anxious. Anxiety is a feeling
> state and we don't program our feelings. What about people who experience
> panic. That can be a very strong feeling rising up out of the body.
> You can't program yourself to experience such a thing.
> ...


I like your posts on this. I have PTSD and you can't just "tell yourself xyz" out of the sometimes extreme feelings and flashbacks, etc.

I agree with, or prefer your approach of feeling the feelings. In my experience, THAT actually lessens them, and feels like true healing too! I personally can't stand the idea of trying to suppress my feelings, even if they are negative; I believe expression heals. It has for me. Not overnight--it still takes time, but I KNOW it's working. And like I said on another website, it's a permanent thing--CBT always seems to be a temporary thing and if the person's not "doing it all the time" it loses its effect. That sounds pretty ineffective to me!


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## SVIIC (Apr 15, 2005)

Invisiblehandicap said:


> It depends on the person. For me, CBT is kind of like taking a panadol for a large wound. It helps, but then the anxiety just comes back. Exposure has worked much better to be honest.


Exposure is still kinda CBT though, isn't it?

At least I always assumed that exposure was considered a part of CBT with OCD... pretty sure it's considered that way.

Anyhow... you do need CBT eventually, right? I mean, no matter what someone does... for their SA to be better, they ultimately have to start going out and socializing at some point and getting used to that. Even a magic pill wouldn't get past that by definition.


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## pbanco (Jan 13, 2013)

SVIIC said:


> Exposure is still kinda CBT though, isn't it?
> 
> At least I always assumed that exposure was considered a part of CBT with OCD... pretty sure it's considered that way.
> 
> Anyhow... you do need CBT eventually, right? I mean, no matter what someone does... for their SA to be better, they ultimately have to start going out and socializing at some point and getting used to that. Even a magic pill wouldn't get past that by definition.


Going out and socializing is....... going out and socializing, it isn't
CBT.


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## SVIIC (Apr 15, 2005)

pbanco said:


> Going out and socializing is....... going out and socializing, it isn't
> CBT.


Yes but if you have terrible SA, then everything social counts as exposure, which is a part of CBT. Same/similar concept anyway: go out and socialize to get better at it and realize your negative assumptions aren't accurate.


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## Samtrix (Aug 22, 2011)

I'm currently trying this out: http://www.social-anxiety-solutions.com/
for non-scary exposure therapy


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## pbanco (Jan 13, 2013)

SVIIC said:


> Yes but if you have terrible SA, then everything social counts as exposure, which is a part of CBT. Same/similar concept anyway: go out and socialize to get better at it and realize your negative assumptions aren't accurate.


Maybe so. For me it worked more like this: I really wanted a
social life, but it was really hard because I got so anxious. My need
for a social life pushed me to action. That's what made me do
therapy. My therapist helped me get in touch with my real
needs and to act on them. Along with trying to socialize, I worked on
the deep feelings that it brought up and that gradually lessoned
my anxiety. Those feelings aren't there to work on unless I do try
to socialize. I have gradually stopped using my avoidance coping behaviors which were obviously ruining my life.


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## pbanco (Jan 13, 2013)

pbanco said:


> Maybe so. For me it worked more like this: I really wanted a
> social life, but it was really hard because I got so anxious. My need
> for a social life pushed me to action. That's what made me do
> therapy. My therapist helped me get in touch with my real
> ...


I want to add to what I said here. My therapist helped me to do
social things by encouraging me. After a few months she stopped 
being so encouraging and understanding. This helped me get to
feelings about having to socialize with no help, and how hard it
is on my own. These are "old" feelings. My mother
gave me very little help. She was unapproachable for me and actually
was the source of a lot of my anxiety. But this was a long process getting to
these old feelings. When CBT therapists are encouraging, what they are
also doing is being helpful in the same way a good parent should be.


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## Twelve Keyz (Aug 28, 2011)

SVIIC said:


> Yes but if you have terrible SA, then everything social counts as exposure, which is a part of CBT. Same/similar concept anyway: go out and socialize to get better at it and realize your negative assumptions aren't accurate.


yeah, that's really all there is to CBT. Why pay someone to tell you what you already know?


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## paulyD (Feb 16, 2011)

Ryukil said:


> If you think about it, CBT is the only way to solve SA that really makes that much sense.


yes and no

cbt is the blueprint for curing S.A. however there are things that you can do to enhance cbt. for example having a few session with an nlp practionaire using techniques such as timeline therapy, fast phobia cure and parts integration can make cbt a lot more effective. mastering and using nlp techniques yourself such as anchoring, modelling, mental rehearsal and self image visualization will also enhance cbt. and last but not least listening dailly to a self help cd such as hypnosis or thinkrightnow will also help to make cbt more effective


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## Mil (Aug 22, 2011)

The cure to SA is expressing what feelings caused you to feel truely ashamed of yourself (Not what causes you now, such as how you act in social situations, since social anxiety is the result of covering up the parts of you that you feel shame for e.g sexual drives, anger, other emotions, which you may not even realise you have because you've numbed them out for so long) to someone who accepts them in you (Who isn't ashamed of something in themselves that you bring out, since they will without meaning to shame you for it as well, by projecting the pain onto you and shaming you), and seeing and hearing for yourself that they accept you.

I think CBT is actually a good starting point, despite what others on this forum has said. I didn't formally do CBT, but I did try changing my thoughts, and at the time I felt like NOTHING, I felt like I didn't exist, I had no identity, because I had repressed myself so much. I looked around me and wanted what everyone else has, this spontanaity, this fun, this assertiveness (Which is actually within all of us, you don't 'get it' from somewhere else, you find it in yourself by doing things that bring it out. of course that's difficult when you are ashamed of showing these parts of yourself), and to keep it short I basically changed my behavior and thought more positively, and sure enough people saw in me these things and responded in that way towards me. Basically it would have been equivalent to CBT, but it was something I did. I'd like to point out I don't and didn't have SA anywhere near as severe as people on this forum, however I definitely was anxious and repressed enough for it to badly negatively impact my life, and it still does, however everyone here can change their lives for the better, and CBT is a great starting point as it helps you 'fit in' to other people better, which will mean people will respond to you better and that's what you need to realise on a subconscious level that you are an acceptable human being AND that you can enjoy and share yourself with others.

Basically, CBT is faking it till you make it, and it focuses away from your being, and perhaps at the beginning it is better to accept the way you feel towards yourself as unacceptable, just because it means you can do the things that will give you results immediately, and thus give you the responses from others that tell you subcosciously that you are an acceptable human being to others.

But the core issue of the shame you truely feel for your self will have to be faced eventually. CBT however probably gives you that spark that will get you inspired to enjoy life again. And help you for now at least act in a way that people will be able to relate to, since most people learn through trial and error about their emotions and themselves, for now it is useful to learn cognitive behavioural techniques that put you in their frame of mind, even if it's in a superficial way, since they will be able to relate to you more and respond in an accepting way, and you'll see for yourself that perhaps the way you feel about yourself and who you are isn't set in stone...


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## moments (Mar 5, 2013)

Depends on the cbt practitioner, your ethnic background, and the original source of your anxiety (which cbt doesn't acknowledge). CBT in its pure form doesn't pay any attention to the historical precedents nor your feelings (or at least your feelings are secondary to cognition, a very Western concept).

If you function well in other areas of your life and only have a specific problem in one are than cbt will likely be very successful. If you have a complicated past including such things as trauma, and anxiety is only part of a dual diagnosis, or you have significant impairment in numerous areas of your life, then it may be more beneficial to do a different strain of therapy (humanistic, psychodynamic, integrative, feminist, etc.) These practitioners are likely to bring behavioral or cognitive components into their work that are helpful.

Personally for me. I got a lot out of my CBT work but it wasn't sufficient for me.


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## Hamster12 (Jun 11, 2012)

CBT was the start of a process for me. It made me realise I wanted to be the most popular person, and I thought I was responsible for achieving that. Once I realised that, I realised that I actually didnt want to be the most popular person, I wanted to choose some friends and find ways of keeping others at arms length. I did group CBT for SA, which was great because it made me realise there were others just like me.

That allowed me to take a step back in social interactions and evaluate people more for their compatability with me. It made me appreciate more who I really am, rather than striving to be a popular person.

I gradually increased in confidence to the point where I am pretty effective at blocking out the presence of people in crowded places except those I'm dealing with directly. I just don't pay attention any more. I don't compare myself to anyone, or at least I try not to. I am what I am and I go about my own business.

And lastly, about 2 years after doing CBT and going thru these gradual mental changes, I realise that what I need to do now is simply project more confidence in social situations. I realise my social skills are a bit lacking, therefore I am at a slight disadvantage in social situations, therefore I feel anxious in social situations. I'm naturally a quiet, serious, earnest, people-pleasing person.

So the step I'm at now is that I am looking into confidence/assertiveness/communications/body language training to help me be perceived as someone to be respected rather than someone submissive or ill at ease. When I master these techniques I will be more confident in social situations, therefore I will feel less anxiety. 

I should say that Valium has really helped my exposure and helped lift the veil from some of the things that I feared, which I don't fear when I take it and can see where my thinking is flawed. 

So for me it's been a gradual process, using a combination of CBT and then later adding medication. And I'm not there yet, but I have very little dread any more and I can face most situations.


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## jangle1 (Jan 11, 2011)

Is CBT the only way to cure SA?

No. The available studies say some can benefit from maois, ssris, snris, and other modalities of therapy.

For me, CBT did not do much towards alleviating my social anxiety symptoms. I did do a rigorous CBT that involved structured and unstructured exposure sessions.


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## CopadoMexicano (Aug 21, 2004)

it depends on what the cause is..I wonder why cbt works for some people but others it doesnt..research has shown cbt and meds to be more effective in treating in sa


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## kungfuchicken (Feb 18, 2013)

What do you do if you don't have the money to pay for expensive therapy sessions?

I looked into CBT therapy and all the places locally wanted $100+ dollars per session.


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## 7th.Streeter (May 11, 2011)

Pam said:


> I like your posts on this. I have PTSD and you can't just "tell yourself xyz" out of the sometimes extreme feelings and flashbacks, etc.
> 
> I agree with, or prefer your approach of feeling the feelings. In my experience, THAT actually lessens them, and feels like true healing too! I personally can't stand the idea of trying to suppress my feelings, even if they are negative; I believe expression heals. It has for me. Not overnight--it still takes time, but I KNOW it's working. And like I said on another website, it's a permanent thing--CBT always seems to be a temporary thing and if the person's not "doing it all the time" it loses its effect. That sounds pretty ineffective to me!


i kinda agree with you..so how do you release?


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## Green Eyes (Sep 6, 2009)

Ryukil said:


> If you think about it, CBT is the only way to solve SA that really makes that much sense.


I'm doing CBT since 1,5 years and it's the only therapy that helped me to get less anxious.


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## bluecrime (Jan 27, 2013)

Sorry, but what is CBT?


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## PaxBritannica (Dec 10, 2012)

ACT is helpful for me


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## Ryukil (Jun 2, 2011)

bluecrime said:


> Sorry, but what is CBT?


Cock and ball torture.


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## decemberxx (Jan 11, 2013)

Who's to say that it's not entirely possible to change your brain's physical structure, at least to some degree, by changing your thinking/behaviors? 

Neuroplasticity. :3


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## Pam (Feb 14, 2009)

mark101 said:


> Feeling a bit anxious about tomorrow,need to go into town and have a coffee somewhere on my own.Some of this treatment feels like punishment but i gots to do it :/


Well, if anything goes wrong, you just have to twist it around in your brain into something good. Right? Lol. Seriously, I hope it went well! And part of CBT is to interpret things in a more positive and realistic way. If a person can't do that, it does feel like torture sometimes, even tho it wasn't really that bad and you are making progress. Let us know how it went!


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## bent (Aug 4, 2005)

I don't think cbt is legit at all. It has a very low 'success' rate and even that is very sketchy as to how they decide when to make a claim of success. It is indeed faking it till you make it as someone above suggested but the reason it doesn't work is that you cannot fake out your own rational mind. you need someone else to fake your mind out if that is indeed the route you want to take, and the fooling of your mind won't be rational since no one gets to having totally irrational thoughts and beliefs out of nothing. If they do have irrational beliefs they got there starting from a rational position with accurate perceptions, otherwise we are talking about psychosis. So only something radical like hypnosis might work. I believe all therapy is fraud because the biggest source of most people's psych issues including SA is in fact the condition of being badly raised, badly mentored, and correspondingly abused indirectly in power dynamics with other people (if not directly abused). Other people validate the developing human from an early age and if they are not able to negotiate a position in the hierarchy that allows them to have confidence in their powers then they develop psych issues. No cbt BS will properly address that. Only having genuine support from a true mentor who will also help the individual redress their socio-political position in a community might be able to help. With different people and different stages and variables there is always some possibility of improvement for everyone but it is not the cbt that will be making the difference. Most therapy (maybe all) is fraudulent and most therapists are actually very bad people posing in a generally unquestioned fantasy bubble of competence in which they make themselves feel better by pretending to help someone they can also look down on while taking their money.


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## max87 (Aug 7, 2010)

In my experience, i don't feel like it's truly a "cure" i've just gone to 4 sessions so it might just be too early. I feel too much peer pressure from this therapist, he is focusing exclusively on the socia area instead of my self esteem and my fears. 
He insists i need a girlfrien i KNOW i need one but i dont know HOW to get one. 
He wants me to go to clubs and bars, but i am afraid he doesn't really see how bad my introversion is and how out of place i feel by all those people joking and laughing and getting absolutely drunk when i despise alcohol due to my family background where alcoholism ruined it for me. 
My crippling shyness won't allow me to talk naturally to a girl, not to mention how overly conscious i am and these thoughts in my head going a 1000 miles per hour make me eel like ****. I then back out thinking on what a bad impression i gave to her. 
My standars aren't exactly "low" so that difficults it even more because i KNOW i am out of her league. 
All these things i feel he doesn't really understand. I have APD, not so much SAD. But they are incredibly similar: http://en.wikipedia.org/wiki/Avoidant_personality_disorder


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## Pam (Feb 14, 2009)

mark101 said:


> Thanks Pam,it wasn't too bad,i stretched two coffee's out for an hour or so and tried to stay in the moment despite feeling pretty conspicuous :/
> 
> I have a really bad habit of zoning out in scary public situations to the point where i'm just in a day dream like state which my therapist says is a big nono lol.
> 
> ...


It sounds like it went VERY well. 

And to the bolded part above--I did the same exact thing in the grocery store. Before I made myself look around, I thought, actually it was more like I KNEW, people were staring at me or giving me dirty looks. But once I looked around and saw that not only were people not giving me dirty looks, they weren't even looking at me. Some here and there, but just in a neutral way. So, it really helps when you do a behavior and really learn something for yourself.

To Bent, I don't usually like CBT but there definitely are times and situations where it can help. I have more than just SA and some of my problems cannot be addressed by CBT so I do other things.


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## Maslow (Dec 24, 2003)

Social anxiety is often caused by low self-esteem. For that reason, CBT alone will not cure you.


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## Ryukil (Jun 2, 2011)

IS social anxiety caused by low self-esteem? I don't know that it is.


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## seaturtle (Apr 22, 2013)

So much misinformation in this thread.

The basic treatment for any type of anxiety is exposure until the anxiety subsides. All anxiety will eventually subside. The key is keeping up the exposure until the anxiety subsides. Then once that is done, you repeat the process. It is a very challenging process but it works if you do it. You can do this by actual exposure to the feared stimuli or you can merely think about the feared stimuli. This process is detailed in the technique known as systematic desensitization. This exposure principle is at the bedrock of all treatments for anxieties. There may be other names or different ways of exposing yourself to the anxiety, but its all really exposure.

Then by anxiety disorders I'm talking about phobias, generalized anxiety disorders, Social anxiety disorder, PTSD. With PTSD I will say one more thing it. Exposure in PTSD is handled with a lot more sensitivity, but exposure is almost always a component of the treatment of PTSD. If you are interested in the treatment of PTSD, look up Seeking Safety and TFCBT.

Now the opposite of systematic desentication can be called systematic sensitization. Every time you find yourself starting to get anxious, you freak out and AVOID the situation that is freaking you out. You then make yourself more anxious and scared the next time you are in that situation. The reason this occurs because you prematurely ended the fear without letting it play out. You never saw how bad it would have got. So your mind has to extrapolate to how bad it would have got if you hadn't left. All too quickly the mind is reduced to fearing the unimaginable terrors of a situation. *note* Trauma is another pathway to anxiety.

Now a little bit about CBT.. CBT is an undefined composition of different cognitive and behavioral techniques and strategies. Basically anything that involves cognitions(thoughts) and behavior can probably be squeezed into CBT. That last sentence is not completely accurate, but its a pretty good rule of thumb.

For those who said CBT doesn't deal with emotions, I will now post the link to the cognitive triangle. Thoughts are linked to emotions, which are linked to behaviors, which are linked to feelings. Change one corner and it has reverberations on the other corners. CBT therapists are very concerned with emotions.

http://www.google.com/url?sa=i&rct=...Yuskpd-lumd0KrfxfYHdhbxQ&ust=1366821844284841

Within CBT there are two main camps. The more cognitive oriented therapist and behaviorally oriented therapist. Then even within these two broad camps there is considerable variability. The Behavioral umbrella is probably the most finely differentiated. ACT (Acceptance and Commitment Therapy) and DBT (dialectical behavior therapy) are two newer therapies under the Behavioral umbrella.

Lastly, some of you have had less than helpful experiences with therapists. Now that is usually more about therapist-client fit than about the therapy itself. Interestingly all therapies intended to therapeutic are about equally efficacious. The first biggest factor that affects treatment outcomes are client factors. This should be obvious. The resources the client brings to the therapy room matters a ton with therapy outcomes. Then the second largest factor in treatment outcomes is the relationship between therapist and client. If they agree on goals, have a good "therapeutic alliance", and can freely discuss the process of treatment this goes along way. Those first two factors account for about 70% of treatment outcomes. Techniques I can't remember if they account for 5 or 15% of variance in treatment outcomes. In either case this whole discussion on techniques is actually what matters least. If you are working with someone who wants to be helpful and have a good working relationship with, you can pretty much guarantee that the relationship will be helpful.


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## pbanco (Jan 13, 2013)

seaturtle said:


> So much misinformation in this thread.
> 
> The basic treatment for any type of anxiety is exposure until the anxiety subsides. All anxiety will eventually subside. The key is keeping up the exposure until the anxiety subsides. Then once that is done, you repeat the process. It is a very challenging process but it works if you do it. You can do this by actual exposure to the feared stimuli or you can merely think about the feared stimuli. This process is detailed in the technique known as systematic desensitization. This exposure principle is at the bedrock of all treatments for anxieties. There may be other names or different ways of exposing yourself to the anxiety, but its all really exposure.
> 
> ...


Your first two sentences are false. There are various types of therapy
for anxiety, not just exposure. If all anxiety eventually subsides then there wouldn't be so many members of this forum.


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## 10PercentExtra (Nov 8, 2009)

Ryukil said:


> If you think about it, CBT is the only way to solve SA that really makes that much sense.


CBT made my SA worse.


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## Maslow (Dec 24, 2003)

mark101 said:


> I expect this is very true,how does one build self esteem?
> 
> Pretty sure i've been operating on low to no self esteem all my life :/


It's all about changing your attitude. Say this out loud: "I am the star of my life; I refuse to settle for a bit part in someone else's life. I am not here on earth to live up to someone else's expectations."

Repeat ad nauseum until you believe it.

But along with that needs to come some successes -- especially with relationships. It also involves finding meaning in life.


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## Maslow (Dec 24, 2003)

Ryukil said:


> IS social anxiety caused by low self-esteem? I don't know that it is.


SA is usually a fear of being judged negatively by others, which means low self-esteem.

What do you think causes it?


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