# Has anyone else found physical anxiety symptoms interfere with carrying out CBT?



## Black_Widow (May 23, 2008)

Recently I've started trying to face largish group situations (around the size of 7 or 8 people) in which I'm expected to speak in front of them as part of some CBT exposure exercises I'm doing at the moment. I've been trying to do this in face to face support group situations. But so far haven't been doing too well. :-( What tends to happen very quickly each time is that as soon as I know it's coming up to my turn to speak my body seems to go into an anxiety freeze state, when I'm so tense that I can barely physically move and I feel I can barely make my throat and voice work because my chest gets so tense. I've found breathing exercises don't help, because my anxiety is already too intense for me to be able to focus on doing them properly. (I find they work better on antipatory anxiety when I'm not directly in an anxiety triggering situation and have more time in which to do them). Also as the situation's not really appropriate for practicing progressive muscular relaxation that's something I feel I can't use either. I know of no other way to successfully calm myself down, other than avoiding saying anything about myself - as unfortunately in these situations it's still the only thing that works. Which is meaning so far I'm failing at carrying out planned exposure's in largish group situations. The physical anxiety symptoms I experience are just interfering too much. 

Wondered if anyone else had been through the same, or at least anything similiar? And if anyone who had, had found a way of being able to get past this obstacle that was helpful? 

Many thanks for reading!

Emma


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## orchdorch925 (Aug 26, 2010)

How long have you been in CBT? I've only been in it for 2 weeks and so far, it seems to be going ok, although sometimes my anxiety at doing something triggers the physical symptoms. For example, last night I went to my college's homecoming dance by myself and my therapist had me talk to 3 guys that I didn't know. At the beginning of the dance, I was having chest pains and sweating and all that stuff. Once I started talking to a guy, my hands were all tingly. So, while I can't exactly relate, I do want you to know that I sometimes have physical symptoms that interfere with my completing of a CBT assignment.


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## Black_Widow (May 23, 2008)

orchdorch925 said:


> How long have you been in CBT? I've only been in it for 2 weeks and so far, it seems to be going ok, although sometimes my anxiety at doing something triggers the physical symptoms. For example, last night I went to my college's homecoming dance by myself and my therapist had me talk to 3 guys that I didn't know. At the beginning of the dance, I was having chest pains and sweating and all that stuff. Once I started talking to a guy, my hands were all tingly. So, while I can't exactly relate, I do want you to know that I sometimes have physical symptoms that interfere with my completing of a CBT assignment.


Hi there Orchdorch925. Many thanks for taking the time to respond that's much appreciated. It's good to know that I'm not the only one who goes through this kind of thing.

I've been trying CBT techniques on and off for roughly the last couple of years. Mostly using advice from a number of different self help books as well as some therapist advice from when I last saw one back in 2008.

Unfortunately even after all this time though this therapy has only helped me to some extent. I still have good and bad days with thought challenging. Sometimes it works and helps me to feel better. Other times not so well. And with all the relaxation methods I've tried, I've found that while they can be helpful with anticipatory anxiety - they're not so good for when I'm in an actual anxiety triggering situation and my symptoms are already at their worst, or very near to their worst. In terms of exposure exercises I've had quite a bit of success with overcoming fears of going to certain public places such as local shops, walking around local streets and visiting my local shopping centre. Using public transport alone is also quite a bit easier for me than it was at one stage - including at busy times. I've also discovered I'm able to cope with some small group situations ok. But as soon as it comes to situations at which I'm at risk of exposing myself to any extra attention before a group of people that's larger than say around 2 or 3 others I seriously start to struggle as that's the kind of situation in which my physical anxiety symptoms come on extra quickly and intensely. Doing an exposure exercise in which I don't have to actually talk to anyone but just be around people for a certain amount of time is something I find doable - even when feeling highly anxious. But speaking to a number of others on top of feeling strongly anxious is another thing altogether. I find it virtually impossible, because of how tense/tight my neck, head, chest and throat get all at once. It gets so strong all I can think about is the need to reduce the symptoms as soon as possible so I can go back to feeling like I normally would. So I feel at the time I have no choice but to say as little as possible so I can calm back down - though I always feel bad afterwards, as again I know I failed at what I meant to do - which was to speak in front of the others and see what happened. At the start of learning about CBT I really hoped using relaxation techniques would help with elimating (or at least greatly reducing) this problem, but so far it hasn't. :-(


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## orchdorch925 (Aug 26, 2010)

Are you taking meds as well? I've heard that a combo of meds and therapy can help. I, personally, have been on Zoloft for almost a month and I think it's help reduce the anxiety a bit, in that I feel less worried and anxious. By no means am I cured, but I think it's helped me somewhat. If you are on meds, I don't know what else to say except address this issue with your therapist. Also, how comfortable are you with your therapist? Because that's important- if you feel comfortable enough to tell them what's going on in your life and what struggles you're having, they can help. Hope I helped you! PM me if you ever need any advice and I'll see what I can do.


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## Black_Widow (May 23, 2008)

orchdorch925 said:


> Are you taking meds as well? I've heard that a combo of meds and therapy can help. I, personally, have been on Zoloft for almost a month and I think it's help reduce the anxiety a bit, in that I feel less worried and anxious. By no means am I cured, but I think it's helped me somewhat. If you are on meds, I don't know what else to say except address this issue with your therapist. Also, how comfortable are you with your therapist? Because that's important- if you feel comfortable enough to tell them what's going on in your life and what struggles you're having, they can help. Hope I helped you! PM me if you ever need any advice and I'll see what I can do.


Hi again Orchdorch925 

Nope not taking meds. Tried 3 different types before and didn't have a good experience with any of them, so decided not to continue on that route in the end. And unfortunately also not seeing a CBT therapist right now, as don't have current access to one. It's a bit of a long story as to why. As a result am having to work at this on my own for now - using therapy advice I was given from when seeing CBT therapist some time ago in the past, as well as working from various CBT self help books, advice I was recently given through a condition management programme I did through my job centre, and a website self help resource.

Still many thanks again for taking the time to reply in here and for the offer of help. Much appreciated.  As a result of some further thinking, feeling at this stage that the only thing left that I can try - that I've not already - is to try breaking this exposure down into smaller steps and seeing if that helps make things more copable. I've got a couple of ideas on how I could try this and have already made a small start with one of them (though because it has been a small start this hasn't yet been enough to start helping with this problem) on it's own. Am thinking it can't hurt to see how this approach goes over the next couple of months or so. If by then there's still no improvement then thinking at that stage I'll definitely have to look into seeing another therapist - much as I'd rather not have to.


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## wxolue (Nov 26, 2008)

First off, why does it matter that you have these symptoms? Why should it matter if you go dumb (unable to speak)? Why should it matter if you stand up there and don't say anything at all? This is exposure therapy. Everyone in the audience already knows you have anxiety, and if they're also members of the group therapy, are guaranteed to be too panicky and stressed out about their own speech to notice if you got up there naked and sung happy birthday. This is exposure therapy. The content doesn't matter. Quite frankly, the speech doesn't matter either. Your goal is to experience as much anxiety as possible. If that means going up there and just standing there smiling at everyone during your 5 minute speech, then do it. If that means going up there and dancing, im sure your therapist would have no objections (barring dancing being an avoidance technique for you).

I have a hunch that you're getting these symptoms because you imagine that they're noticeable, or that they're making your voice sound weird (if its not, please correct me). If so, I just laid out your negative thought right there. Do some cognitive restructuring, tell yourself they AREN'T noticeable and it wouldn't matter even if they were, talk through the whole speech for your next group, and prove yourself wrong. Good luck.


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## millenniumman75 (Feb 4, 2005)

The symptoms in a way are always going to be there. We have to learn to press through that wall. Once we get a hang of it, trying new things becomes fun.


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## Black_Widow (May 23, 2008)

wxolue said:


> First off, why does it matter that you have these symptoms? Why should it matter if you go dumb (unable to speak)? Why should it matter if you stand up there and don't say anything at all.


My current exposure aim is to at least to get in the habit of saying a few coherent sentences in front of others in a largish group situation. If I can't physically speak any words because of the intensity of these anxiety symptoms then that means I can't carry the exposure task through. Meaning I've made no progress. Naturally, this isn't something I want as it's the opposite of what I'm trying to achieve, so that's why it matters.




wxolue said:


> Everyone in the audience already knows you have anxiety, and if they're also members of the group therapy, are guaranteed to be too panicky and stressed out about their own speech to notice if you got up there naked and sung happy birthday.


You make some very good points there. While the support group is mainly for sufferers of depression, some do also suffer anxiety. Probably at least some of them are much more concerned with their uncomfortable feelings rather than focusing as much on me as I'm thinking they are. Thanks for pointing all that out, much appreciated! That's a helpful perspective.




wxolue said:


> This is exposure therapy. The content doesn't matter. Quite frankly, the speech doesn't matter either. Your goal is to experience as much anxiety as possible. If that means going up there and just standing there smiling at everyone during your 5 minute speech, then do it. If that means going up there and dancing, im sure your therapist would have no objections (barring dancing being an avoidance technique for you).


I think I may have given a somewhat misleading impression on what I was getting at in my earlier posts, because of the way I typed/phrased my sentences. Apologies on the confusion! I'll explain further where I'm coming from.

Yes I'm doing exposure therapy. But this isn't a task I was given to do by anybody running this depression support group service. I planned it on my own using suggestions out of self help books that advise on how to use CBT tecniques. I'm not currently seeing a therapist. I'm going to these depression support group sessions (they're not therapy sessions, just part of a support service offered through a charity organisation) regularly to put myself in the right kind of circumstances in which to tackle my group speaking fears. However, hardly any of the others I've so far met who regularly attend know this is what I'm doing. I tend to keep it private. I'm sure most likely if I did admit it to people they'd have no problem with it. But as my reason behind doing this kind of exposure is to increase my confidence in approaching team work meeting/discussion situations - and in a work situation it would be alot less appropriate to talk about that kind of thing with anybody - I want to prepare myself for dealing with that. So that's why I don't make a big thing out of telling anyone.

Anyways, again my current exposure goal is to get into the habit of speaking just a few shortish sentences in these situations in front of others. (eventually I'm hoping to move onto talking for longer time lengths once I've hopefullly gained some confidence here). Sitting there, smiling and saying nothing would totally defeat the object. Also when you say my speech content doesn't matter, to some extent it does. Because in some respects it's not entirely different to a work meeting situation - where I would generally be expected to contribute something verbal wise. These support groups aren't really so different to meetings. One main reason they're there, is for anyone who's a member of the depression service charity they're run by to share opinions and information about the main depression related topic of the group for that day. Sharing opinions and information tends to be the idea behind a work meeting too. In that kind of situation, when inevitably at some stage I'd be asked to share an opinion or information, if I kept repeatedly taking the attitude "well it doesn't really matter if I don't say anything." and then kept avoiding doing so, then that wouldn't do my job prospects much good! It'd be likely my colleagues and boss would assume it was a sign of a lack of enthuasiasm and unwillingness to put any effort in. Of course, with the depression support group situations I'm putting myself in at the moment, this is somewhat different. Nobody is going to outright complain if I don't talk much, as people are allowed to say as much or as little as they want to. But still, it's preferred that people do talk. As without any discussion taking place, it'd defeat the aim of the support group for that day. Plus if I keep relying on that as a safety behaviour then it's not going to give me the confidence needed in the future to tackle facing a work group discussion situation effectively. Which for me is a problem right now. 



wxolue said:


> I have a hunch that you're getting these symptoms because you imagine that they're noticeable, or that they're making your voice sound weird (if its not, please correct me). If so, I just laid out your negative thought right there. Do some cognitive restructuring, tell yourself they AREN'T noticeable and it wouldn't matter even if they were, talk through the whole speech for your next group, and prove yourself wrong. Good luck.


Your hunch is pretty much right. And appreciate you taking the time to post your cognitive restructuring suggestion there. Many thanks for that. Unfortunately for me, that specific one doesn't 100% fit my past life experiences. Far from it. So in my case, I don't find that telling myself that kind of thing helps. But still, I guess it can't hurt to attempt a cognitive restructuring exercise and see what else I can come up with. Will give it a whirl! Thanks for the luck too. 




millenniumman75 said:


> The symptoms in a way are always going to be there. We have to learn to press through that wall. Once we get a hang of it, trying new things becomes fun.


Thanks Millennium. Will try to bear those positive words in mind.


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## VC132 (Sep 1, 2010)

Black_Widow said:


> Recently I've started trying to face largish group situations (around the size of 7 or 8 people) in which I'm expected to speak in front of them as part of some CBT exposure exercises I'm doing at the moment. I've been trying to do this in face to face support group situations. But so far haven't been doing too well. :-( What tends to happen very quickly each time is that as soon as I know it's coming up to my turn to speak my body seems to go into an anxiety freeze state, when I'm so tense that I can barely physically move and I feel I can barely make my throat and voice work because my chest gets so tense. I've found breathing exercises don't help, because my anxiety is already too intense for me to be able to focus on doing them properly. (I find they work better on antipatory anxiety when I'm not directly in an anxiety triggering situation and have more time in which to do them). Also as the situation's not really appropriate for practicing progressive muscular relaxation that's something I feel I can't use either. I know of no other way to successfully calm myself down, other than avoiding saying anything about myself - as unfortunately in these situations it's still the only thing that works. Which is meaning so far I'm failing at carrying out planned exposure's in largish group situations. The physical anxiety symptoms I experience are just interfering too much.
> 
> Wondered if anyone else had been through the same, or at least anything similiar? And if anyone who had, had found a way of being able to get past this obstacle that was helpful?
> 
> ...


I think you're doing a really good job, Emma.

In the beginning, I felt like breathing exercises were useless too haha. Perhaps, you could start smaller like with a person that looks more approachable and have some success first, then move up. It's important that we meet with at least some success in the beginning.

If I may, I want to toss in random stuff that hit home with me.


Start small; there is no need to change your life overnight. Starting slowly increases your chances for success, feeling more confident to move to the next level.
Perhaps, most importantly, I recognized when I showed improvement. Giving myself credit when credit was due was one of my proudest achievements.
There is no benefit in completing an exposure and then denigrating ourselves about how we think we did.
So often when people are anxious, they are looking inward, tuning into their own experience-and because they feel so awful, they think they are performing poorly. Because of this inward focus, they're not able to notice cues around the that would help them appropriately judge how they're really doing. We tend to denigrate ourselves.


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## Black_Widow (May 23, 2008)

VC132 said:


> I think you're doing a really good job, Emma.
> 
> In the beginning, I felt like breathing exercises were useless too haha. Perhaps, you could start smaller like with a person that looks more approachable and have some success first, then move up. It's important that we meet with at least some success in the beginning.
> 
> ...


Hey there VC132

Many thanks for the positive encouragement from you too. Really appreciate you taking the time to post all that. After feeling in pretty low spirits for the last couple of days, reading what you said has really helped me to feel better. And what you say there makes alot of sense. Agreeing, it would be better if I tried to be less harsh on myself, continue to focus on just taking small steps for now, and give myself credit for the small things I do have success with. Even though I've not had that with everything I've attempted/want to achieve so far. You are totally right. Beating my self up over things I've not not yet had success with, and not giving myself credit for the things I have, leads to no benefit at all. It doesn't help anything. Will bear that in mind for future times I start to get down on myself.


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## wxolue (Nov 26, 2008)

To flesh out a little bit more my first comment...

My explanation of an exposure exercise came from what I learned in therapy. I just finished my 3 month CBT session. For the behavioral therapy (i.e. exposure therapies), we were taught that the goal of exposures was simply to experience as much anxiety as possible. Behavioral therapy is not about becoming more comfortable doing activities that provoke anxiety by doing them over and over. 

-Behavioral therapy is about countering an unnatural physiological way of coping with anxiety that actually perpetuates and intensifies the anxiety. 

-It's also a supplement to cognitive therapy - sort of physical proof that the negative thoughts that have lead to our anxiety really are baseless.

(I can go more in depth on both of these things if you'd like)

Because of both of these purposes, exposure therapy tends to help us in all aspects of our lives (all aspects that are affected by anxiety that is). Going through exposure exercises in public speaking also help with initiating conversations, speaking to authority figures, being the center of attention, etc.

For example: I used to have a good deal of anxiety when entering a sexual situation with a girl. Naturally I couldn't have sex with anyone in therapy to simulate the situation, but I really didn't have to. Because the exposures helped other areas where I struggled with anxiety, this sex anxiety improved over time without even focusing on it.

My cognitive restructuring was just an example, feel free to design one that works best for you.


If not talking would be an avoidance measure for you, then don't do it haha. I guess all I can suggest is to belt out your speech if you have to and not worry how it sounds when it comes out. Good luck!


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## VC132 (Sep 1, 2010)

Black_Widow said:


> Hey there VC132
> 
> Many thanks for the positive encouragement from you too. Really appreciate you taking the time to post all that. After feeling in pretty low spirits for the last couple of days, reading what you said has really helped me to feel better. And what you say there makes alot of sense. Agreeing, it would be better if I tried to be less harsh on myself, continue to focus on just taking small steps for now, and give myself credit for the small things I do have success with. Even though I've not had that with everything I've attempted/want to achieve so far. You are totally right. Beating my self up over things I've not not yet had success with, and not giving myself credit for the things I have, leads to no benefit at all. It doesn't help anything. Will bear that in mind for future times I start to get down on myself.


Ya! No problem. I'm glad I could help!

Exposure isn't easy. I still struggle with exposure therapy in my daily life. For you to discover it _on your own_ and put all these things into action _on your own_, IMO, is nothing short of a-w-e-s-o-m-e, and inspiring for me! Go Black Widow, lol.


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## Black_Widow (May 23, 2008)

wxolue said:


> My explanation of an exposure exercise came from what I learned in therapy. I just finished my 3 month CBT session. For the behavioral therapy (i.e. exposure therapies), we were taught that the goal of exposures was simply to experience as much anxiety as possible. Behavioral therapy is not about becoming more comfortable doing activities that provoke anxiety by doing them over and over.
> 
> -Behavioral therapy is about countering an unnatural physiological way of coping with anxiety that actually perpetuates and intensifies the anxiety.
> 
> -It's also a supplement to cognitive therapy - sort of physical proof that the negative thoughts that have lead to our anxiety really are baseless.


I kind of get the idea we've been taught slightly different things out of CBT teachings, and as a result are talking at cross purposes here!

I also saw a CBT therapist for about 3 months - between late 2007 and early 2008. When we started our work together she recommended two CBT based self help books to me - both of which I still own and both of which are written by experienced CBT professionals. In addition, later on I also picked up another couple of similar CBT self help titles - also written by CBT experienced professionals - which covered CBT exposure in quite a bit of depth.

It was through reading this book literature, and also listening to what the CBT therapist I was seeing had to say, that I learned about the CBT _graded exposure _technique. And this way that I learned that the idea behind graded exposure, is to learn _both_ how to tolerate feelings of anxiety and gradually desensitize yourself to the specific anxiety provoking situations that cause problems for you until you are comfortable with them. As a starting point, using pen and paper exercises, you create a systematic _gradual_ set of steps (a hierarchy) in relation to whatever specific anxiety related fear you want to tackle. For example it might be a fear of spiders. Or a fear of using the supermarket. (in my case I'm currently trying to work on my fear of being the centre of attention in front of a number of people, which public speaking falls into). It's then advised to start with the easier steps and work your way up to the more difficult one's. With each step it's advised to perform it the needed number of times (observing what happens while experiencing the anxiety you do) until you learn either that your worst fears don't come true, or even if they do that it's not the end of the world - and as a result your anxiety reduces to the point you do eventually feel a lot more comfortable. Then you move on to the next step and start again, till you've mastered that one. Then move onto the next step after that and so on - till you've eventually mastered the hardest one. 

Anyways, when you say behavioural therapy (I'm assuming you're referring to the behavioural aspect of CBT and not some other kind of therapy) is not about becoming more comfortable doing activities that provoke anxiety by doing them over and over, in regards to the graded exposure technique I strongly disagree. As that's a major part of exactly how it's supposed to work. Therefore I must point out your implication that I'm approaching my exposure exercises in the wrong way is incorrect. Admittedly, you'd be correct if I were following the kind of exposure method you described - but I'm not. I'm using the CBT graded exposure method. 



wxolue said:


> (I can go more in depth on both of these things if you'd like.


Appreciate the offer of more info. But I'm fine there thanks.



wxolue said:


> For example: I used to have a good deal of anxiety when entering a sexual situation with a girl. Naturally I couldn't have sex with anyone in therapy to simulate the situation, but I really didn't have to. Because the exposures helped other areas where I struggled with anxiety, this sex anxiety improved over time without even focusing on it.


Again, sounds to me like as if a different therapy exposure approach was used to that of CBT graded exposure. Which very much involves testing out your fears in real life situations outside of therapy (you can also use imaginary exposure exercises with graded exposure, but from the information I've so far learned I get the idea you're supposed to use it in combination with testing your fears out in real life situations to obtain the most benefit). Whichever exposure technique that happened to be , honestly not knocking it!  Obviously it worked effectively for you. Which is good.  And I appreciate you mentioning it here to try to help. But for me personally, using the graded exposure approach suggested in my self help books and by my old therapist is what I feel is the most logical choice for me right now. Although if in the long run it doesn't work out, then will most definitely be considering other ideas.



wxolue said:


> My cognitive restructuring was just an example, feel free to design one that works best for you.


Going by the way you phrased your text, that wasn't obvious to me before. But if I did misunderstand, my apologies.



wxolue said:


> If not talking would be an avoidance measure for you, then don't do it haha. I guess all I can suggest is to belt out your speech if you have to and not worry how it sounds when it comes out. Good luck!


Those suggestions sound like a very good one's. Will give them a try. Thanks for them and the luck again.


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## Black_Widow (May 23, 2008)

VC132 said:


> Ya! No problem. I'm glad I could help!
> 
> Exposure isn't easy. I still struggle with exposure therapy in my daily life. For you to discover it _on your own_ and put all these things into action _on your own_, IMO, is nothing short of a-w-e-s-o-m-e, and inspiring for me! Go Black Widow, lol.


That's very kind of you to say so VC132 and thanks again.  I feel you give me slightly too much credit though. :b I didn't strictly discover the exposure techique on my own. Had a helping start from a therapist a few years back lol . But still, I do take all that as a very big compliment and highly appreciate it. Good luck with your exposure too. Certainly sounds to me as if you're moving along the right track, and already making good progress. In turn for me that's also inspiring for me to hear about!


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## wxolue (Nov 26, 2008)

I think your version of CBT fits in quite well with my version. A lot of our exposure therapies were based around public speaking. When we started, we made a list of the most anxiety provoking topics for public speaking, and put them in an anxiety hierarchy (just like you describe). Talking about finance was relatively low on my list, but talking about gay/lesbian rights was very high. The purpose of this is the same as what you describe: obviously they aren't going to throw us into the MOST anxiety provoking situation on the first day. It may sound like I'm contradicting myself, but while planning an exposure can be based on a stepping up from lower anxiety provoking situations to higher ones, while in an exposure, the goal is to experience as much anxiety as possible. Put differently, while in an exposure, it is important that you are not using avoidance techniques that would otherwise mitigate your anxiety.



I would like to flesh out one of my previous statements.

"Behavioral therapy is not about becoming more comfortable doing activities that provoke anxiety by doing them over and over."

Behavioral therapy (the B part of CBT, yes) does involve doing certain exposures over and over. Through behavioral therapy, we do become more comfortable with doing certain activities. I'm actually not sure exactly why I said this, as your response to this specific statement is more compatible with the therapy that I did than this statement here. The only reason I could think of saying this is that I wanted to emphasize the importance of experiencing anxiety in exposures. Being 'comfortable' in an exposure therapy shouldn't be like using avoidance techniques to become comfortable in a situation that provokes anxiety. The goal of doing an exposure should have nothing to do with being comfortable, but experiencing anxiety. Only after doing an exposure with this goal in mind (also making sure you aren't using avoidance techniques) for an extended period of time should feeling comfortable be a good thing. At any rate, what I wrote down didn't really reflect my intentions behind the statement.

The only real difference I see between our forms of CBT is that mine praises the fact that doing one exposure tends to help your anxieties in other areas unrelated to the specific exposure (If your CBT also praises this, my apologies). Having this in mind, as I got further along in my exposures, it would be harder for me to get really strong anxiety from doing a public speaking exposure. Topics no longer bothered me. I had reached the top of my hierarchy. At this point, my therapist started incorporating anything to get me to feel more anxiety - wearing purple hair, arguing the opposite side of a contentious issue, starting an argument with one of my audience members, stating an obviously incorrect fact, coughing profusely throughout my exposure. At this point, the reasons for using a hierarchy - making sure I wouldn't be scared away from therapy - were no longer relevant to me. I had been in therapy for long enough that I was well aware of the success of behavioral therapy.

I hope you can look past my misstatements and see what I see - that our forms of CBT are actually a lot alike.

In the end, my only concern throughout this whole thread is that your inability to speak was actually an avoidance in disguise (avoidance can be tricky like that). From personal experience, it was often hard for me to see that something I was doing was an avoidance technique, since I was doing it for so long. It was helpful to have an outside perspective (a therapist or another group member in my group therapy) on some habits that turned out to be avoidance techniques. In this thread, I was trying to be that outside perspective. This is a problem though, since I know very little about you as a person, your anxiety, this situation, ect. It wouldn't make sense for me, some random person on the SA forums to start making brash statements about what a problem you have is or isn't. It could very well be a physical symptom of anxiety, and could have nothing to do with avoidance. I urge you to also consider the possibility of it being an avoidance technique. I am leaning towards the latter, as I've never heard of adrenaline physically disabling someone's vocal chords, but don't trust me for a second - I'm not a doctor or a therapist. I compel you to speak to a CBT therapist about this and get a professional perspective on it.


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## roverred (Dec 23, 2007)

Definitely, CBT is awesome but I find it pretty much useless during high anxiety moments. If you are able to control thoughts it can help turn down the anxiety, but usually when anxiety hits it is so overwhelming that CBT is not even in your head. For me, I find CBT is for prior to the event and after the event. 

Honestly, I think this one of those tough situations that you can't reduce the anxiety with self-talk. It's those situations where you have to accept the anxiety and do exposure therapy and learn to have the correct post-mortem logic for this specific situation. It won't lessen the anxiety unless you have it. 

But have you tried imagining the situation before hand and trying to discover all the negative thoughts and irrational logic? The immediate and the deep rooted ones. Then coming up with planned counter thoughts so you don't have to wing it. Then you constantly imagine it over and over and over, until it becomes almost a reflex when those same thoughts occur. 

There's also something called NLP. Some people thinks it's nonsense, but I find actually makes some sense. From what I read, which is not much lol, it seems to be more geared towards immediate anxiety reduction rather than solving deep problems. A lot of the techniques seem to be the same concept as above, but uses a lot of association with imagery to leave a bigger impact.


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## Black_Widow (May 23, 2008)

*It may sound like I'm contradicting myself, but while planning an exposure can be based on a stepping up from lower anxiety provoking situations to higher ones, while in an exposure, the goal is to experience as much anxiety as possible. *

Before I respond further to this point, just going to ask - are you saying that's the goal of each exposure task? Or are you saying that's the long term goal of exposure - as a result of completing all of the hierarchy steps? 

*Put differently, while in an exposure, it is important that you are not using avoidance techniques that would otherwise mitigate your anxiety.*

Ah, so that's what you mean! Fair enough! But in the case of the exposure I was referring to in my first post in here, that's something that didn't apply. Maybe I didn't make that as clear as I could have done with the way I phrased my post though. Just to further clarify, I didn't choose to avoid anything. What happened is that my anxiety quickly magnified to the point my throat and chest became very tense and tight and I found it very hard to catch my breath. This was what interfered with how well I was able to speak at the time. It's not really too different to what an asthma suffer most likely goes through at the start of an attack. Because they're getting short of breath in a fast amount of time, they start to struggle to speak. My experience, at times like that, is similiar. As as soon as I'm around the right kind of trigger, my physical anxiety response is very fast to come on. Only admittedly in my case, the cause is without a doubt psychological rather than physical. I'm definitely not claiming otherwise.

*I would like to flesh out one of my previous statements.*

*"Behavioral therapy is not about becoming more comfortable doing activities that provoke anxiety by doing them over and over."*

*Behavioral therapy (the B part of CBT, yes) does involve doing certain exposures over and over. Through behavioral therapy, we do become more comfortable with doing certain activities. I'm actually not sure exactly why I said this, as your response to this specific statement is more compatible with the therapy that I did than this statement here. The only reason I could think of saying this is that I wanted to emphasize the importance of experiencing anxiety in exposures. *

Sure.  Certainly not disagreeing with you on that either. I'm in absolutely no doubt some anxiety most definitely needs to be experienced in an exposure task. There'd be no point in doing it if it were 100% easy and some anxiety wasn't experienced. The only thing I don't currently agree on, is that within any exposure task that it's necessarily helpful (at least not for everyone) to make the task one that provokes anxiety symptoms at their most overwhelming at the time. The way I've been taught is it's best to strike a balance between not making the task too easy, but not too overwhelmingly hard at the time either. Otherwise with the latter this can actually be counter productive when it comes to making progress.

*The only real difference I see between our forms of CBT is that mine praises the fact that doing one exposure tends to help your anxieties in other areas unrelated to the specific exposure (If your CBT also praises this, my apologies). Having this in mind, as I got further along in my exposures, it would be harder for me to get really strong anxiety from doing a public speaking exposure. Topics no longer bothered me. I had reached the top of my hierarchy. At this point, my therapist started incorporating anything to get me to feel more anxiety - wearing purple hair, arguing the opposite side of a contentious issue, starting an argument with one of my audience members, stating an obviously incorrect fact, coughing profusely throughout my exposure. At this point, the reasons for using a hierarchy - making sure I wouldn't be scared away from therapy - were no longer relevant to me. I had been in therapy for long enough that I was well aware of the success of behavioral therapy.*

*The only real difference I see between our forms of CBT is that mine praises the fact that doing one exposure tends to help your anxieties in other areas unrelated to the specific exposure (If your CBT also praises this, my apologies).*

Have to admit, out of everything I've read on using the CBT graded exposure technique -and everything I heard from my therapist - that I never read/heard anything like that as being claimed to be the specific aim of exposure. But absolutely no need to apologise! I'm in no doubt what you're telling me there is true. And actually the idea makes total sense to me. As actually in recent days I've had something similar start to happen. Making telephone calls is another area in which I get anxious - but have not yet started to tackle systematically through exposure steps (though it's been on my list of things to do CBT wise). Because I've recently developed new confidence in other areas - such as using public transport at busy times when there's a lot of young kids and teenagers around, visiting café's and the library alone, that's actually what led me to try making that phone call to someone I know this morning! Ordinarily I'd have just avoided it and sent her a text message from my mobile phone. But I was thinking along the line's of "well I tried those other things, and in the end had some success with them - so why not?" I highly doubt I'd have reached even that point if not for developing that new confidence with doing other things. I'm in no doubt that kind of thing can occur as a very helpful side effect of doing CBT exposure!

*I hope you can look past my misstatements and see what I see - that our forms of CBT are actually a lot alike.*

I agree. It does sound to me like they're similiar - but as far as I'm seeing with just a couple of differences.

*In the end, my only concern throughout this whole thread is that your inability to speak was actually an avoidance in disguise (avoidance can be tricky like that). From personal experience, it was often hard for me to see that something I was doing was an avoidance technique, since I was doing it for so long. It was helpful to have an outside perspective (a therapist or another group member in my group therapy) on some habits that turned out to be avoidance techniques. In this thread, I was trying to be that outside perspective. This is a problem though, since I know very little about you as a person, your anxiety, this situation, ect. It wouldn't make sense for me, some random person on the SA forums to start making brash statements about what a problem you have is or isn't. It could very well be a physical symptom of anxiety, and could have nothing to do with avoidance. I urge you to also consider the possibility of it being an avoidance technique. I am leaning towards the latter, as I've never heard of adrenaline physically disabling someone's vocal chords, but don't trust me for a second - I'm not a doctor or a therapist. I compel you to speak to a CBT therapist about this and get a professional perspective on it.*

Highly appreciate the concern! And thanks again for taking the time to share your thoughts. But as I mentioned before, I'm in absolutely no doubt it's an anxiety symptom as I'm already aware that what happened in the situation had nothing to do with using avoidance techniques.


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## mind_games (Nov 30, 2008)

Maybe work on a goal that is slightly lower on the exposure ladder (well this depends on your particular levels of comfort). What if you worked on staying silent for now and instead make a goal of making prolonged eye contact with another member(s) in the group. It means the pressure/expectation/performance anxiety involved with freezing up physically can be relieved as you only need to use you eyes. It involves being the centre of attention too; nothing like feeling people's eyes on you to make you feel judged. Is this a group where you can arrange for that sort of thing? 

^This assumes you find making eye contact less challenging than speaking.
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Or staying with the speaking goal you can break it down even within the speaking goal. What do you aim to say when it comes to your turn in the group? Saying a whole sentence can seem quite daunting. Maybe it's better to start with a simple and short goal of saying "Hi." for a few group sessions. (take a deep breath and blurt out 'Hi' as you exhale. Maybe practice at home and imagine/visualise yourself doing it this way before your turn comes). As you get more comfortable you can add more words.

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At school I used to do a countdown in my head from 10 and at zero I'd attempt to just blurt out whatever I had to say. It was effective some of the time. I'd kinda gear myself up for blurting out my comment by just concentrating on the countdown (by counting in my head and visualising the numbers) and not on the anxiety. The point was to use the distract myself from the anxiety and feel like I'd committed myself to speaking out once the countdown started.


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## Black_Widow (May 23, 2008)

Hi there Mind Games, many thanks for taking the time to reply and for including all those ideas there. Highly appreciated! 

I'm pretty much taking your suggested approach at the moment. 
Since making my first post in here I managed to attend another time and things went alot better. I managed to speak a few sentences in front of about 11 other people or so that time. It helped that I rehearsed just a few times beforehand the jist of what I was going to say. And basically taking the attitude "what the heck I'm just going to do it no matter what happens." I think it also helped that I had some unexpected distraction at the last minute, which meant noticing another person at the group appeared to be in an even more anxious state than I was. Feeling concerned for her made me temporarily forget my anxiety just before I started the speech. Because of that I found that once I started speaking, that time I had no problem belting out words. I think there might have been times I talked a bit too fast for people to have necessarily understood me - as I felt in such a rush to get the whole thing over with. But that was the only problem that occurred while I talked that time. Funnily enough my anxiety actually didn't start to hit me till after I'd finished. Like a delayed reaction. I think what happened was that initial concern for that other person combined with the urge to get on and do what I had to do made me forget to feel anxious for the whole time I was talking. But as soon as I was finished and not doing anything more, the distraction effect wore off and then it returned. Although by that point I could see nobody was taking any notice of me. The conversation moved on. People were absorbed in saying what they wanted to. So noticing that did help calm me back down after so long. Though I realise it would have been better to attempt that with no distraction present - I still felt it was a start! At least I now know I'm not totally incapable of doing it. I'm going to repeat this step a few more times and see how things go. Although if at any point I start to struggle again I may well consider temporarily back tracking to a smaller step, such as just saying one sentence or two. Or maybe just two or three. Rather than about 5 or 6 as I did that time. Your eye contact idea is a good one too, as that's something I'm lacking practice on. Will definitely be bearing that one in mind. Many thanks again!


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