# CBT is useless.



## naes (Nov 1, 2013)

I believe psychotherapy, more specifically Cognitive Behavioral Therapy (CBT) is useless. I think it is nothing more than an extension of freudian psychology. To believe that uncontrolled irrational anxiety is nothing more than the cause of a faulty thinking cycle astounds me. This type of thinking is a huge distraction to the actual problem which lies in the physiology of the anxious mind. This is a biological problem! Most people with social anxiety are completely aware of their irrational anxiety but it doesn't matter! To be clear I believe irrational anxiety to be automatic and uncontrolled non-beneficial anxiety towards a stimulus in the environment. The fact that this is automatic response that has nothing to do with reasoning skills makes it pretty obvious in my mind that this isn't something that can be solved by telling someone their anxiety is irrational and they need to practice going into situations where they will have anxiety. Anyways, i believe psychotherapy is a placebo and at best can only help give a patient outside knowledge that will help them cope with their disability. It does NOT treat the source of the problem though. I would question anyone who believes psychotherapy to be an effective treatment to really ask themselves if their anxiety has gone away or been reduced because of the therapy. I think psychotherapy is a dishonest tactic used to trick people into thinking they are being treated. It is my opinion that it is really only busywork for the brain with no actual clinical significance. I hate hearing about people wasting their money and time on a useless treatment method.


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## DiscardYourFear (Oct 19, 2015)

naes said:


> Anyways, i believe psychotherapy at best can only help give a patient outside knowledge that will help them cope with their disability. * It does NOT treat the source of the problem though. I would question anyone who believes psychotherapy to be an effective treatment to really ask themselves if their anxiety has gone away or been reduced because of the therapy. * I think psychotherapy is a dishonest tactic used to trick people into thinking they are being cured. It is my opinion that it is really only busywork for the brain with no actual clinical significance. I hate hearing about people wasting their money and time on a useless treatment method. I think it is nothing more than a distraction to finding the actual cure for the anxious mind and the sooner this is realized the better.


Incorrect. It does, in fact, treat the source of the problem. That's what the cognitive side of CBT is all about. Getting to the source of all of your irrational thinking and reworking your thought processes. 
If you are looking for a "cure" for anxiety, be prepared to be miserable all of your life. Everyone is anxious to some degree. People with anxiety disorders have a disproportionate amount of anxiety given the situation. So of course CBT reduces anxiety rather than "curing" it. A certain amount of anxiety is actually important for survival. You can't just magically make it go away. Instead, you learn to cope with it appropriately, as someone who does not have an anxiety disorder already does.


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## SplendidBob (May 28, 2014)

DiscardYourFear said:


> Incorrect. It does, in fact, treat the source of the problem. That's what the cognitive side of CBT is all about. Getting to the source of all of your irrational thinking and reworking your thought processes.
> If you are looking for a "cure" for anxiety, be prepared to be miserable all of your life. Everyone is anxious to some degree. People with anxiety disorders have a disproportionate amount of anxiety given the situation. So of course CBT reduces anxiety rather than "curing" it. A certain amount of anxiety is actually important for survival. You can't just magically make it go away. Instead, you learn to cope with it appropriately, as someone who does not have an anxiety disorder already does.


I will start by saying that I _don't_ think CBT is useless.

I do however think (in the way it is typically taught) CBT is incorrect about causation. It seems to slip into a weird dualistic way of thinking that the brain is just a container for our thoughts.

Every thought is a physical thing. Every one. We might not be able to understand what that physical representation is, but it can be nothing else, because _everything is physical_.

The difference between someone crippled by anxiety and one who doesn't suffer anxiety is a _physical_ difference. Learned behaviour, learned avoidance, heightened physiological response are physical things within the brain and body (we might not know what they are, we might be able to reverse them with the correct therapies, but they must be physical, *because there is nothing non physical*). If we say otherwise then we are working with a dualistic model, and a dualistic model is scientifically nonsense.

What *isn't* going on here is that the non anxious person is simply having more rational thoughts about their anxiety. What is happening is that the anxious person is having either a stronger biological anxiety response, or their brains are reacting to the anxiety stimulus in a more sensitive way.

Science is beginning to show the biological variations within the brain that leads to these variations (see amygdala, hippocampus etc). We know that some people have genes that make them more susceptible to stress, and that this will likely manifest in anxiety / depression, and that the structures involved in the brain that regulate these things (and literally how they are physically built) will affect the anxiety and how the individual behaves.

CBT and other therapies can potentially help sufferers with mental health problems. They can help to limit the stress that the brain get placed under, they can change thinking style perhaps, and maybe they even can affect biological structures long term, but it is backwards to say that the thoughts are the_ cause_.

So whilst I don't agree with the OP that CBT is useless, its likely way over hyped because it seems to be assuming some kind of dualistic model (certainly in the therapists I have had), so the obvious biological issues aren't given proper consideration.

This is a frustration I have personally when dealing with CBT therapists. Despite me knowing full well that the majority of OCD experts now accept biological causation for OCD, I had to sit and listen to (a very competent) CBT therapist telling me that the reason she doesn't have trouble with OCD thoughts was because she 'doesn't allow herself to be bothered by them'. Not allowing herself to be bothered by them is the result of _ her brain functioning properly_ in this respect, not something she is simply choosing to do that I am not. It isn't something I can simply alter if I will it to be.

I don't know if I have made myself clear here though tbh - I am still slight inebriated and talking about mind / brain is always a little bit tricky


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## 1Pet57 (Dec 6, 2014)

naes said:


> This is a biological problem! Most people with social anxiety are completely aware of their irrational anxiety but it doesn't matter! To be clear I believe irrational anxiety to be automatic and uncontrolled non-beneficial anxiety towards a stimulus in the environment. The fact that this is automatic response that has nothing to do with reasoning skills makes it pretty obvious in my mind that this isn't something that can be solved by telling someone their anxiety is irrational and they need to practice going into situations where they will have anxiety.


I was frustrated with this in CBT - So much of it was trying to get me to acknowledge the rational thought process I must be having behind my anxious response.... but it is just NOT rational. Suddenly my heart is racing and I'm breathing heavily before going into my boss's office, NOT because I rationally thought "he's going to yell at me" or "he's going to fire me" and then I got anxious. I never thought those things at all.

Thanks for your post.


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## VanDamme (Jun 8, 2004)

CBT has it's place. SA affects many areas: beliefs, thinking, feeling, behaviour.

If the issues you are dealing with are *pure* beliefs or thoughts, then you can use various counter evidence based approach to challenge and change your thinking. CBT is a good approach for those.



naes said:


> To be clear I believe irrational anxiety to be automatic and uncontrolled non-beneficial anxiety towards a stimulus in the environment.


I agree, that most often there's also a trigger based feeling (fear, shame, embarrassment) component and CBT doesn't work well for that.

Interestingly, if those feeling intensity is low enough then the behaviour/exposure part of CBT may take care of them. But, if the feeling intensity is medium to high, then CBT won't work. It didn't work for my issues and neither did for many others I've met. But I found other approaches that did now all my SA issues are gone.

I noticed that people talk about two types of anxiety:
-Transient. Sometimes you have it, other times you don't.
-Predictable: you always experience it consistently and may be triggered by thoughts, events, situation. The good thing about predictable anxiety is that chances are that something emotional happened (e.g. you were scared) and the brain stored connected that event to something present i.e. created a trigger based response - much like Pavlov's classical conditioning but with feelings.

And that's why CBT, drugs and many other approaches often fail because they don't address that trigger memory. But, there are many approaches that do and some are highly efficient and effective.

A saw a documentary about changing phobias (i.e. high intensity fear response) mentioned two approaches to desensitize (i.e. remove) the fear response. One was hypnosis. For many people, a single hypnosis session was enough to eliminate the fear response. 
If that doesn't work, then there's also gradual desensitization. Some can find visualizing the situation working, others need the actual exposure. Here's an example link: http://www.guidetopsychology.com/sysden.htm

There are other approaches that can desensitize the trigger memory. I wrote about those here: http://www.socialanxietysupport.com...re-nervous-1620025/index2.html#post1082727569

Sometimes, there may be limiting beliefs or other issues present that also need to be dealt with, as mentioned here: http://www.socialanxietysupport.com/forum/f9/y-all-still-be-socially-anxious-because-1659753/



DiscardYourFear said:


> Incorrect. It does, in fact, treat the source of the problem. That's what the cognitive side of CBT is all about. Getting to the source of all of your irrational thinking and reworking your thought processes.


As I mentioned above, thinking is only one aspect but CBT doesn't deal with the feelings.

[Note: when I talk about anxiety, I'm referring to the predictable type as mentioned above]



DiscardYourFear said:


> People with anxiety disorders have a disproportionate amount of anxiety given the situation.


That's not true. How many people feel anxious standing in a line or talking on the phone? Most don't so it's not a proportion issue but rather a context/situation based anxiety issue that only some people have.



DiscardYourFear said:


> If you are looking for a "cure" for anxiety, be prepared to be miserable all of your life. Everyone is anxious to some degree. People with anxiety disorders have a disproportionate amount of anxiety given the situation. So of course CBT reduces anxiety rather than "curing" it. A certain amount of anxiety is actually important for survival. You can't just magically make it go away. Instead, you learn to cope with it appropriately, as someone who does not have an anxiety disorder already does.


Yes, there are "cures" that can completely desensitize the trigger memory. I know from my and others' experience.

Brain science isn't really at a point where it can give concrete answers about what exactly anxiety/fear is. So it's up to us to explore.

Of course, there is also the "transient" anxiety. For that different "reactive" approaches such as various attention interrupting or directing such as meditation tend to work for many.


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## Noca (Jun 24, 2005)

I use bits and pieces of CBT all the time for my SA and OCD, and it works great. I only find it minimally effective for depression however. I have used the ERP type of CBT to successfully eradicate my OCD hoarding and obessive checking rituals permanently. I use it still to manage my OCD related to germs, though it tends to manage the condition rather than effectively remedy it. I am sure if I had more time and energy to devote to doing so that I could have a chance of overcoming that as well. 

As for SA, well I use CBT to cope with my anxiety often when I am out in public. I have specifically focused on treating my SA in the past and while it never completely dissapeared it definitely was much less of a problem than it had been prior to starting CBT. I find SA is one of those things where the more you avoid working on it the worse it gets and the more you work on it the better it gets, for me it never really went away completely, it required ongoing work.

I often don't rely on just CBT, I use bits and pieces of CBT, ACT, and DBT as well as my own cognitive strategies I designed myself.


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## naes (Nov 1, 2013)

splendidbob said:


> I will start by saying that I _don't_ think CBT is useless.
> 
> I do however think (in the way it is typically taught) CBT is incorrect about causation. It seems to slip into a weird dualistic way of thinking that the brain is just a container for our thoughts.
> 
> ...


All good bro i respect your opinion, i can see why you think cbt might be useful in some regards. Btw for being slightly inebriated you typed that post pretty well! I understood very well what you were saying. I'm pretty ****ed up right now too btw, I had a pretty rough day...i think i'm guna make a thread about it in a moment lol.


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## naes (Nov 1, 2013)

DiscardYourFear said:


> Incorrect. It does, in fact, treat the source of the problem. That's what the cognitive side of CBT is all about. Getting to the source of all of your irrational thinking and reworking your thought processes.
> If you are looking for a "cure" for anxiety, be prepared to be miserable all of your life. Everyone is anxious to some degree. People with anxiety disorders have a disproportionate amount of anxiety given the situation. So of course CBT reduces anxiety rather than "curing" it. A certain amount of anxiety is actually important for survival. You can't just magically make it go away. Instead, you learn to cope with it appropriately, as someone who does not have an anxiety disorder already does.


I have to respectfully disagree. Btw even though i felt that was an inappropriate comment telling me that i will be miserable all my life i just like to contend that i was miserable but i had this state of mind. Furthermore, what is wrong with wanting an actual cure? To tell you the truth if i didn't think there was a cure i would probably end it all. Fortunately from what I have read regarding breakthroughs in science I have hope that some new drugs and treatments will come on the market someday in my lifetime that will make it possible for me to live a somewhat normal life. Atm i am just trying to survive long enough to make it to that day. Also, like Vann said, normal people don't get anxious standing in line or being around people, etc...


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## naes (Nov 1, 2013)

VanDamme said:


> CBT has it's place. SA affects many areas: beliefs, thinking, feeling, behaviour.
> 
> If the issues you are dealing with are *pure* beliefs or thoughts, then you can use various counter evidence based approach to challenge and change your thinking. CBT is a good approach for those.
> 
> ...


Thanks for the links bro, i'll try to make sure to check them out.


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## VanDamme (Jun 8, 2004)

naes said:


> Thanks for the links bro, i'll try to make sure to check them out.


You're welcome. Let me know if you any questions.


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## naes (Nov 1, 2013)

VanDamme said:


> You're welcome. Let me know if you any questions.


For sure man. Btw random question lol, wut r u taking to get "slightly inebriated" atm?
Edit: woops that was bob who said that. NVM xD


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## sabbath9 (Dec 30, 2014)

CBT and meds didn't help me much either. But Acceptance and Commitment Therapy (ACT) has helped me a great deal. You can learn ACT from self-help workbooks. One of the best is "Get Out of Your Mind & Into Your Life" by Dr. Steven C. Hayes.


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## millenniumman75 (Feb 4, 2005)

It depends on how you use it.
I just went back to an old lesson about stress, anger, and mood swings. I had forgotten about what to do. These are skills we are supposed to be carrying with us.


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## DiscardYourFear (Oct 19, 2015)

naes said:


> I have to respectfully disagree. Btw even though i felt that was an inappropriate comment telling me that i will be miserable all my life i just like to contend that i was miserable but i had this state of mind.* Furthermore, what is wrong with wanting an actual cure? To tell you the truth if i didn't think there was a cure i would probably end it all. * Fortunately from what I have read regarding breakthroughs in science I have hope that some new drugs and treatments will come on the market someday in my lifetime that will make it possible for me to live a somewhat normal life. Atm i am just trying to survive long enough to make it to that day. *Also, like Vann said, normal people don't get anxious standing in line or being around people, etc..*.


When I said "you", I meant the universal you, not you personally. What is wrong with wanting a cure is that it will give you false hope. I used to want a cure. I just wanted my anxiety to go away by taking a pill. Unfortunately, it doesn't work that way.

I respectfully disagree that normal people don't get anxious around people. Because as my own negative thought processes have been changing, I notice they do get anxious, they just have ways of dealing with it that doesn't impact their lives as it does ours. Yes, their anxiety is not as intense as ours, but that's because they have not lived a life time of self abusive thoughts. They don't let the negativity in as somebody with an anxiety disorder does.

I don't think there is no biological component to anxiety disorders and depression, but to hope for a cure that way is not addressing the entire problem. And from my own experiences, nurture has a lot more impact on who you are than nature.


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## VanDamme (Jun 8, 2004)

DiscardYourFear said:


> What is wrong with wanting a cure is that it will give you false hope. I used to want a cure. I just wanted my anxiety to go away by taking a pill. Unfortunately, it doesn't work that way.
> 
> I respectfully disagree that normal people don't get anxious around people. Because as my own negative thought processes have been changing, I notice they do get anxious, they just have ways of dealing with it that doesn't impact their lives as it does ours. Yes, their anxiety is not as intense as ours, but that's because they have not lived a life time of self abusive thoughts. They don't let the negativity in as somebody with an anxiety disorder does.


I wanted a "cure" ... and found something that essentially could be called a cure. Of course, I'm not talking about a pill (now those at best address symptoms) but techniques that change beliefs and learned memory based trigger processes (as I mentioned in my post above). I don't have any anxiety in the situations where I used to have very high intensity anxiety (more fear with some worries). At this point, I'm not even coping because ... there is nothing that needs coping with.

The good thing about nurture based issues is that (most likely) can be changed but require the right approach as I wrote about.

Attending anxiety support groups during the last ten years, one of my most interesting observations was that what people BELIEVE anxiety to be will determine the steps they take and their results.
Q: Do you believe that anxiety can be changed or will it be there for the rest of your life and at best can be managed?
For those that say "Yes" (like me) will keep looking and trying things until they overcome anxiety (i.e. it's gone in the specific situations). Those that say "No", will look for ways that allow them to manage anxiety.


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## naes (Nov 1, 2013)

DiscardYourFear said:


> When I said "you", I meant the universal you, not you personally. What is wrong with wanting a cure is that it will give you false hope. I used to want a cure. I just wanted my anxiety to go away by taking a pill. Unfortunately, it doesn't work that way.
> 
> I respectfully disagree that normal people don't get anxious around people. Because as my own negative thought processes have been changing, I notice they do get anxious, they just have ways of dealing with it that doesn't impact their lives as it does ours. Yes, their anxiety is not as intense as ours, but that's because they have not lived a life time of self abusive thoughts. They don't let the negativity in as somebody with an anxiety disorder does.
> 
> I don't think there is no biological component to anxiety disorders and depression, but to hope for a cure that way is not addressing the entire problem. And from my own experiences, nurture has a lot more impact on who you are than nature.


But do you have proof that it doesn't work that way? Do you have proof that normies get anxiety everytime they walk outside their door? Anyways it doesn't sound like we will reach a conclusion unless you can provide me proof on those 2 things which i doubt you will be able to so i think in this circumstance it's ok to agree to disagree. I respect your opinion, thank you for sharing it.


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## naes (Nov 1, 2013)

VanDamme said:


> You're welcome. Let me know if you any questions.


Sorry to say but i checked out your links and it seems like a lot of pseudoscience to me. I don't believe social anxiety is caused by beliefs. I already addressed that I am convinced it is a biological problem. I think CBT and other methods could help with changing your beliefs though, which can be a good thing if they are distorted or irrational (which tends to happen as a cause of SA), but as far as curing SA, i believe it to be ineffective. I'm glad it works for you though.


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## Caedmon (Dec 14, 2003)

Are you aware of the overwhelming body of research showing that Cognitive-Behavioral Therapy is effective?

Why the false dichotomy of anxiety as a biological process, exclusive of appraisal? Do you really think that we think with something other than our... you know... _brains_? Or that information and appraisal has no effect on downstream neurological events?

Thought exercise: If you heard someone break into your house would you feel apprehensive?


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## naes (Nov 1, 2013)

Caedmon said:


> Are you aware of the overwhelming body of research showing that Cognitive-Behavioral Therapy is effective?
> 
> Why the false dichotomy of anxiety as a biological process, exclusive of appraisal? Do you really think that we think with something other than our... you know... _brains_? Or that information and appraisal has no effect on downstream neurological events?
> 
> Thought exercise: If you heard someone break into your house would you feel apprehensive?


Why are you asking me instead of providing any of this overwhelming amount of data you speak of? I'm being objective to CBT, if you want to convince me that is reputable then why don't you provide empirical proof for it's efficacy and the scientific logic behind why it works? There's no reason to try to get into a petty bickering match with me.


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## Caedmon (Dec 14, 2003)

Waiting for your answer to my questions.


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## VanDamme (Jun 8, 2004)

Caedmon said:


> Are you aware of the overwhelming body of research showing that Cognitive-Behavioral Therapy is effective?


Effective for what exactly? Even if you say that it's effective for SA, why did it not work for me and many others that I've met at various anxiety support groups over 10 years?

On the other hand, I've also met many people who found it effective. So, I wondered why did it work for some and not for others.

Essentially, I found the same thing as I just read http://www.socialanxietysupport.com/disorder the other day: CBT can be effective for mild to moderate SA. However, for intense (like mine) it won't work.

So, you can't say that it's going to work for every type of SA but it certainly can work for many.

Actually, it did work for certain types of thought patterns that I had. But those were negligible compared to the physical symptoms of the fear response.


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## VanDamme (Jun 8, 2004)

naes said:


> Sorry to say but i checked out your links and it seems like a lot of pseudoscience to me. I don't believe social anxiety is caused by beliefs. I already addressed that I am convinced it is a biological problem. I think CBT and other methods could help with changing your beliefs though, which can be a good thing if they are distorted or irrational (which tends to happen as a cause of SA), but as far as curing SA, i believe it to be ineffective. I'm glad it works for you though.


I was lucky in some sense that my anxiety issues (even though very intense) were the "classic" type. Something negative happens (fear, same, embarrassment) either once (intense trauma) or many repeated events and the brain stores that negative feeling related to a certain aspect of the context. Then, when that same aspect is recognized, the feeling is recalled/triggered. In a way, it's one example of the classical conditioning but with feelings. That's what most of my issues were. I didn't even have beliefs nor thinking issues - e.g. many people worry what others may think about them. I just had the fear response (heart racing, sweating, etc). As mentioned in my reply to Caedom http://www.socialanxietysupport.com/forum/f43/cbt-is-useless-1662009/index2.html#post1083376386 that's why CBT didn't work for most of my issues.

Only a small number of the techniques mentioned in the links work with beliefs but most of them work with the context based feelings memories. That's why they are effective at desensitizing because they change that context based memory so it doesn't trigger the same feeling any more. In conditioning terms, some are essentially memory extinction because they can change memories quickly. Others might be described as memory memory reconsolidation (i.e. update).

Have you read the book mentioned in another thread: Joseph LeDoux, "Anxious: Using the Brain to Understand and Treat Fear and Anxiety". While he talked about a number of brain processes and regions involved in fear and anxiety, as far as therapy is concerned, he basically listed the currently commonly used ones. What I found most interesting was that he even mentioned hypnosis briefly. But as far as better understanding and diagnostics are concerned, we still have to wait for a while.

As mentioned in the book, there are 4 ways to be anxious:
-danger is present or near, in time or might be coming in the future
-internal trigger stimulus (body sensation)
-triggered by thoughts or memories
-thoughts or memories (existential dread) about meaningful life, inevitability of death, difficulty of making decisions that have moral value.

So, when you say SA biological problem, are you thinking about the same thing as I mentioned above or something else?


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## bluecrime (Jan 27, 2013)

CBT is useless for some but helpful for others. Hasn't worked for me, but has for others. The problem I have is people who think it's the ONLY solution to SA. For some it just simply does not and can not help. I wish a greater number of treatments where offered.


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## Hylar (Jul 15, 2014)

CBT certainly does work for some people. Yet for others it's maybe less effective. It has a good reputation for treating anxiety related mental disorders, although this doesn't mean it's for everyone. For me it helped a little, but I had to reach a point where I really wanted to get better, before I actually started to improve. You can see a therapist for years, but if deep down you don't have a strong desire to improve then it's likely you wont.


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## vicente (Nov 10, 2003)

When my rational mind disagrees with my emotional mind the emotional mind usually wins and CBT fails. It makes me want to cry when I can't change my thought patterns, feelings, and behavior to match what my rational mind knows.

CBT works best when you're also doing something to change your core beliefs.


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## Caedmon (Dec 14, 2003)

VanDamme said:


> Even if you say that it's effective for SA, why did it not work for me and many others that I've met at various anxiety support groups over 10 years? CBT can be effective for mild to moderate SA. However, for intense (like mine) it won't work.


No idea on the Why question- I'd only be able to speculate. There is literature on the factors that seem to influence success in broad subject samples: most notably, adherence to treatment and presence of comorbid disorders. I don't know if that's true that a given treatment necessarily won't work just based on severity, but I'm sure that severity could _influence_ treatment outcome or require more prolonged, intense treatment. I don't think I would rule out CBT though.



> I didn't even have beliefs nor thinking issues - e.g. many people worry what others may think about them. I just had the fear response (heart racing, sweating, etc).


It might be worth mentioning that cognitions are not always linguistic self-statements. They may be images or non-linguistic appraisals.

Appraisals of a given situation are always involved. Appraisals also mediate whether those physiological symptoms are _maintained_ which is a big part of what allows an anxiety disorder to persist. There may be a stimulus that triggers an anxiety response but the response is more continuous and meaningful when paired with a negative threat appraisal.

I do think simplistic ABC cognitive models don't always suffice to explain the phenomenon of social anxiety. (Activating Event -> Belief -> Consequence) although there is some great truth in it.

The two big cognitive "models" of social anxiety disorder are by the researchers Clark & Wells, and also by Rapee & Heimberg. Good stuff.

A great deal of the work that may help is not just *cognitive reappraisal* but also removing *safety behaviors* (which act to maintain the anxiety) and reducing *self-focused attention* (same). We all check in from time to time on "how things are going" in a situation. The checking-in, itself, can be marked by unhelpful beliefs. It may not preceed a situation but it is still a causative factor.

As a semi afterthough, here is a great resource that explains the tie-in between appraisals and chronic stress. I think it shows how cognitive processes and physiology are interrelated. 
"The Anatomy & Physiology of the Human Stress Response" (Everly & Lating, 2013). I know it isn't specific to SA.

Self-focused attention and attempts to control or hide anxiety, are mental acts that themselves can either trigger or maintain a physiological response. "Oh no, I feel anxious!" [let's skip the trigger itself, if you like] --> attempts to control anxiety, and self monitoring --> assessment of current situation as threatening.

Though really, this is a feedback loop and not linear.

____

As a general rule, for appraisals: 
Perceived cost (threat, risk) x Perceived probability (likelihood of threat) = Anxiety

Overestimated threat ("I need to look confident or my boss will think less of me") x Overestimated probability ("I look weak and stumble over my words, and my boss can see this now") = Social Anxiety.

Apologies if I come off as pedantic and said what you already know.


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## Caedmon (Dec 14, 2003)

I always figured it was a given that social anxiety could be multifactorial. Right?

+/- Physiological predisposition (biological factors)
+/- Negative life experiences (conditioned responses)
+/- Challenging life circumstances (background anxiety, comordbidity)
+/- Acquired negative beliefs about the self, the world, others (cognitive appraisals)
+/- Intensity of given stimulus (perceived cost of "failure")
= development and presence of social anxiety

So a treatment that helps to improve beliefs about the self, how appraise social situations, how to realistically assess social threats, and hierarchically reduce conditioned responses, should be helpful. And indeed CBT is helpful and effective. See:
Optimal treatment of social phobia: systematic review and meta-analysis (Canton et al, 2012). One stop shopping for "what works".


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## SplendidBob (May 28, 2014)

There is a bit of a problem with studies for psychological therapies though isn't there? That is that it is almost impossible to double blind the study. Is this even attempted with CBT studies? - that is, that the person giving the therapy doesn't know if its CBT or placebo they are giving?

Just asking out of ignorance and throwing this out there, because I can't figure out how double blinding could be achieved for CBT in a study (perhaps I am stupid). How much of the evidence base for CBT doesn't double blind? (its just something I always wondered about).


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## Hayman (Dec 27, 2014)

I have limited experience of CBT, so I can only discuss this to a small degree. I did attend an initial assessment appointment for the course, which lasted an hour and a half from memory. I was taken to a room, much like standard doctors consulting room only smaller, and I had to basically pour my heart out to a lady behind a desk.

This was several years ago now so my memory is a little hazy on exact details, but I recall her asking me if there was anything I'd done to try and "_help myself_". Something I've since heard over and over and over again. An ironic statement to make given you've actually gone to seek help for the very reason you can't help yourself&#8230; I wouldn't have been there otherwise . I explained what I'd done and whilst she was satisfied with a few answers and couldn't comment to any solution within the timescale of the appointment, she was basically dismissive of everything else I had to say - saying it wasn't enough e.t.c&#8230; Again, I take you back to my point of seeking help because I couldn't do any more myself.

To conclude the meeting, she went over of what the course entailed. Cutting a long story short, it was nothing more than a "_face your fears_" course. I wouldn't be alone either - it would be with a bunch of other people. What a wonderful idea - putting someone with SA in a room with complete strangers . Not only was that a hurdle to climb over in itself, she didn't know how to reply when I told her I already faced my fears. Daily. That's what causes me to be the way I am. Doing more of the same thing wasn't going to somehow cure me. It would send me even further into my shell. Oh yes, and if I missed one session (there was six, I think), I'd be kicked out of the course. So, no pressure there then&#8230;  No thought whatsoever about all the time I had to arrange off work because they couldn't do weekend sessions. Another anxiety raiser for me&#8230;

It was clear it just wasn't going to be for me. I could see in her face that she knew that too.

Needless to say, I shook her hand, thanked her for basically wasting my time and not understanding the situation/condition (in more amicable words I admit, but I wasn't happy) and I left.

I honestly think that some people are just too far gone to get help. I fear I may be one of them. Until I can find someone who can 'come down' to my level and accept what I'm saying, I can't see myself moving forwards from this. I need someone to toss me down a rope, rather than expecting me to jump 10ft or more before I can just about touch it with my fingertips. It seems help is there...if you're already improving or have friends to support you. If you're at 'Stage One' with no friends, such as myself, you're pretty much screwed. You have nothing to work from, but medical professions seem to merely 'presume' you have support coming from elsewhere before-hand.

This is how I see it, anyway...


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## knightofdespair (May 20, 2014)

The problem is SA is fear + *constant reinforcement*. People can learn to deal with fears, if they are unfounded. If driving makes you anxious because people are always up your *** or cutting in front of you, driving more is just going to reinforce those feelings. Feeling anxiety about using a urinal doesn't go away when every time you go to use one strangers are coming in the door and standing there next to you, it will just get worse. Feeling anxiety about getting in a fight is going to get worse if you keep getting your *** kicked...


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## srschirm (Jun 25, 2006)

DiscardYourFear said:


> When I said "you", I meant the universal you, not you personally. What is wrong with wanting a cure is that it will give you false hope. I used to want a cure. I just wanted my anxiety to go away by taking a pill. Unfortunately, it doesn't work that way.
> 
> I respectfully disagree that normal people don't get anxious around people. Because as my own negative thought processes have been changing, I notice they do get anxious, they just have ways of dealing with it that doesn't impact their lives as it does ours. Yes, their anxiety is not as intense as ours, but that's because they have not lived a life time of self abusive thoughts. They don't let the negativity in as somebody with an anxiety disorder does.


I largely agree with this.


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## VanDamme (Jun 8, 2004)

Hayman said:


> I honestly think that some people are just too far gone to get help. I fear I may be one of them. Until I can find someone who can 'come down' to my level and accept what I'm saying, I can't see myself moving forwards from this. I need someone to toss me down a rope, rather than expecting me to jump 10ft or more before I can just about touch it with my fingertips. It seems help is there...if you're already improving or have friends to support you. If you're at 'Stage One' with no friends, such as myself, you're pretty much screwed. You have nothing to work from, but medical professions seem to merely 'presume' you have support coming from elsewhere before-hand.


I agree that finding the right approach for your situation can make a difference.

I was somewhat lucky overall that I only needed to find information and could do the rest by myself. I've never done any therapy but hearing many people's experiences, it wouldn't have made difference. I would've just received the same info that I found myself. Actually, that's not exactly true. Most common approaches (CBT, meditation, relaxation, desensitization) only worked for a few issues but I needed to look further for other approaches to deal with my specific issues. Nowadays, you can find lots of info on the internet - though sometimes you have to keep digging.

But I know that some people prefer a more direct help.

If by "rope" you mean perhaps some info/approach that could address certain issues (i.e. reduce fear in certain situations) that you haven't tried yet, let me know.

Hope you find what you are looking for.


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## rickey (Jun 22, 2010)

I think CBT is useful for anxiety. Especially if the therapist knows relaxation techniques, it helps take care of physical symptoms of anxiety. But recently, I've been thinking to myself that I may be mistaking anxiety for "insecurity". For example, if you asked me to go to a meetup group (doesn't matter the theme), I have no problem putting my shoes on and taking the train out to the event, spend a couple of hours glaring around, and go home. But the thought that will almost always stop me from going is "what am I going to do with myself there? Talk to people?" This is very different than when I was thinking, "I dont want to go cause I wont talk and people will hate me for not talking". In either case, the not-interested-in-talking bit still exists in my mind. Me and therapist are still working on this. But at least now I wont assume people will hate me. 

Maybe this improvement was a result of CBT, maybe as I got older my brain matured and got rid of irrationalities on its own. It's better not to dwell on it.


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## VanDamme (Jun 8, 2004)

rickey said:


> I think CBT is useful for anxiety. Especially if the therapist knows relaxation techniques, it helps take care of physical symptoms of anxiety. But recently, I've been thinking to myself that I may be mistaking anxiety for "insecurity". For example, if you asked me to go to a meetup group (doesn't matter the theme), I have no problem putting my shoes on and taking the train out to the event, spend a couple of hours glaring around, and go home. But the thought that will almost always stop me from going is "what am I going to do with myself there? Talk to people?" This is very different than when I was thinking, "I dont want to go cause I wont talk and people will hate me for not talking". In either case, the not-interested-in-talking bit still exists in my mind. Me and therapist are still working on this. But at least now I wont assume people will hate me.
> 
> Maybe this improvement was a result of CBT, maybe as I got older my brain matured and got rid of irrationalities on its own. It's better not to dwell on it.


Figuring out what causes the issue can be challenging. Sometimes, there might even be multiple anxiety trigger issues that need to be dealt with separately.

I posted a number of possible anxiety triggers here: http://www.socialanxietysupport.com/forum/f13/lefkoe-belief-process-23294/#post1082877873

That post is part of one approach that works for some for certain issues. If interested, you can check it out (there are free sample videos for certain beliefs) or just ignore it.


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## Hayman (Dec 27, 2014)

VanDamme said:


> Nowadays, you can find lots of info on the internet - though sometimes you have to keep digging.
> 
> But I know that some people prefer a more direct help.
> 
> ...


Thanks. I think I'll start to do some serious research on the internet when I get more free time. Personally, I'd prefer speaking to someone but so far I think I've spoken to four(?) different doctors and that lady in CBT over the years. None of them seem to actually understand what Social Anxiety actually is or what depths of shyness or fear the sufferers go though. What they suggest is basically what everyone claims you can just 'do' on someone's say-so and why I went to them in the first place because I _can't_ do what they say... That was the whole point of seeking help from them in the first place! It really doesn't bode well for face-to-face contact from my experience and I just found it incredibly frustrating.

I do honestly think self-help could be the only answer for me. The only problem with that is that I do have three self-help books at home...and they're neither use nor ornament either. They just repeat the same old military-style demands of 'get' this and 'be' that - without actually telling you how to go about this if you're on the floor. They also all presume you have friends to talk to... Again, there's help out there for those who have come crumbs of comfort to cling onto. 'Stage Two' as I'd call it. There's nothing out there that I've found for those at 'Stage One' who have literally nothing other than either a sea of negativity aimed towards you or fresh air to work from.

By 'rope' I meant that to be the help in order for you to get out of the hole that you're in. From my experience, it only ever goes so far down that hole in order to rescue you. It's never quite long enough to reach the very bottom where I am. Again, it's presumed that you already have something behind you to help you climb up to that 'Stage Two' and therefore the rope is always about 10ft too short! You can jump and _almost_ reach it, but never quite. It taunts you and makes you even more frustrated. It seems you're entirely alone when it comes to climbing up from 'Stage One' and this is where I'm at.

I think the only way 'Stage Oners' such as myself can actually move forwards is, somehow, trying to find some sort of comfort within themselves and try and find some happiness in being alone. Look after themselves, rather than trying to listen to others to make them happy (seeking satisfaction) and you miserable... A way of being a bit more self-sufficient basically, as I don't believe there really is any help for those right at the bottom. I honestly don't see any other way out, or around rather, from this...


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## newbornmind (May 6, 2012)

Anxiety in my experience and belief is a "bottom up" process. Meaning it's a problem generated in your emotional brain. Emotions come first, and then create the negative and limiting thought patterns that anxiety sufferers find themselves in. 

I think any method worth it's salt has to work from the bottom up, instead of using a "top down" approach (like CBT). So methods that work with feelings and emotions are much more powerful, and actually can stand a chance of helping people make changes IMO.


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## Caedmon (Dec 14, 2003)

splendidbob said:


> There is a bit of a problem with studies for psychological therapies though isn't there? That is that it is almost impossible to double blind the study. Is this even attempted with CBT studies? - that is, that the person giving the therapy doesn't know if its CBT or placebo they are giving?
> 
> Just asking out of ignorance and throwing this out there, because I can't figure out how double blinding could be achieved for CBT in a study (perhaps I am stupid). How much of the evidence base for CBT doesn't double blind? (its just something I always wondered about).


Right, you wouldn't do a double blind placebo controlled study on psychological therapy. It works much better for drug studies (which have their own issues.) There are varieties of ways to control for confounding factors in behavioral studies such as investigator blindness, participant randomization, etc... You would also use different statistical methods to assess the significance of treatment. For example using Odds Ratio to assess likelihood of the treatment having a meaningful difference, or using Effect Size to assess. It's really a case of apples vs oranges.

If you look at the article I linked above it compares various treatments via a single metric, effect size. As the abstract notes:

"...Cognitive behavior therapy appears to be more effective than other evidence-based psychological techniques, and its effects appear to be more enduring than those of pharmacotherapy. There is some evidence, albeit limited to certain drug classes, that the combination of medication and cognitive behavior therapy may be more effective than either strategy used alone..."

(You can get the nitty gritty numbers in the tables.)


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## VanDamme (Jun 8, 2004)

Hayman said:


> Thanks. I think I'll start to do some serious research on the internet when I get more free time. Personally, I'd prefer speaking to someone but so far I think I've spoken to four(?) different doctors and that lady in CBT over the years. None of them seem to actually understand what Social Anxiety actually is or what depths of shyness or fear the sufferers go though. What they suggest is basically what everyone claims you can just 'do' on someone's say-so and why I went to them in the first place because I _can't_ do what they say... That was the whole point of seeking help from them in the first place! It really doesn't bode well for face-to-face contact from my experience and I just found it incredibly frustrating.
> 
> I do honestly think self-help could be the only answer for me. The only problem with that is that I do have three self-help books at home...and they're neither use nor ornament either. They just repeat the same old military-style demands of 'get' this and 'be' that - without actually telling you how to go about this if you're on the floor. They also all presume you have friends to talk to... Again, there's help out there for those who have come crumbs of comfort to cling onto. 'Stage Two' as I'd call it. There's nothing out there that I've found for those at 'Stage One' who have literally nothing other than either a sea of negativity aimed towards you or fresh air to work from.
> 
> ...


Thank you for your reply. It makes more sense now.

I wish I could give better advice as to what to do. But it does sound like you at least have some idea of what direction you need to take.


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## VanDamme (Jun 8, 2004)

newbornmind said:


> Anxiety in my experience and belief is a "bottom up" process. Meaning it's a problem generated in your emotional brain. Emotions come first, and then create the negative and limiting thought patterns that anxiety sufferers find themselves in.
> 
> I think any method worth it's salt has to work from the bottom up, instead of using a "top down" approach (like CBT). So methods that work with feelings and emotions are much more powerful, and actually can stand a chance of helping people make changes IMO.


I agree that emotions and thougths are one separate level and need to be addressed as such. Especially emotions that CBT and other approaches tend to ignore.

But CBT is still useful for thinking related issues and there are issues where thinking is the main issue (with slight fear/anxiety). In that case you need to focus on dealing with thoughts first. If the fear feeling is low to moderate, "simple" exposure can even take care of that. For example, I've heard from and met people who found becoming a waiter or giving speeches at Toastmasters enough to overcome SA (i.e. mainly the fear feeling).


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## VanDamme (Jun 8, 2004)

Thank you for your replies. 



Caedmon said:


> Apologies if I come off as pedantic and said what you already know.


Actually, yes I am very familiar with what you wrote.  However, it's good to know that we are on the same page. Also, up to now I focused mostly on overcoming "my SA". As one of the organizers of an SA support group, I like to hear about other's experience because then I can give better advice for others - even if my experience was different. So, I'm trying to create a model or map that could be useful for giving suggestions as to what steps/direction people can take in terms dealing with SA. Your replies sum up the topic well.

As you mentioned there are many factors that determine success. I would also add support. Some people can motivate themselves, others need external motivation (e.g. another person). Also, "carrot or stick" type motivation needs to be considered.

It's interesting in one of the links you mentioned that Social Phobia is used rather than SA or SAD. My experience was actually fairly "simple" compared to most as most of of my issues were SP (i.e. feeling of fear) with some "What if ..." type worry thoughts (e.g. can't give a speech > no job > no money > no survival). Developing CBT type balanced and/or interrupting thinking into habits worked on those. However, the fear feeling was trickier to deal with - even though it was the predictable trigger based type and not the random type (sometimes you feel other times you don't).

In a way, I was lucky that most of my issues were the context based SA (often very intense panic attack types though). Only avoided a handful of situations but somehow I was still able to push through most of them. Of course, muscle tension and mind going blank, and other symptoms did hinder certain aspects but so far had a reasonably "normal" life. I had no problems with beliefs about myself or others.



Caedmon said:


> So a treatment that helps to improve beliefs about the self, how appraise social situations, how to realistically assess social threats, and hierarchically reduce conditioned responses, should be helpful. And indeed CBT is helpful and effective.


I agree, that should work. I expected it to do so, but ... it didn't

First time I've attended Toastmasters for 9 months regularly my SA did not change. Also, participated in many social situations without much progress. As I think back now, maybe the issue was that the hierarchy wasn't there. Any event that I tried triggered high intensity fear e.g. even just meeting one or a few new people and I'm not even sure if I could've found a lower intensity situation. Also, I remember reading that the fear response should decrease after 15 minutes or so but I was easily be in fear mode for the entire two hours of any Toastmasters meeting.

About 11 years ago, I started another "attempt" to reduce the fear feelings. Found one support group and went back to Toastmasters. Also started exploring various relaxation and meditation techniques. Don't really know what worked because there were some strange aspects. I did notice the fear symptoms started to decrease, but very slowly. After four years, I almost didn't do anything for about a year or so, yet the rate of change remained the same. Some suggested that maybe the previous work somehow continued, but I had a feeling that something was keeping that slow rate.

Interestingly, I do have an "explanation" that will probably sound strange if you are not familiar with communicating with the subconscious (e.g. hypnosis). As I mentioned, about 11 years ago change started. I had a "feeling/thought" that my progress is like a big boulder with cracks appearing slowly. I can remove the pieces but I can't speed it up (e.g. use power tools or dynamite). I've also met more than a dozen people over the years, and nobody was able to speed up the process. However, as I mentioned the rate of change was slow but constant. For lower intensity issues, the change finished earlier. Another interesting aspect was that for situations, that weren't covered by a solid boulder (i.e. haven't experienced a lot of fear) I could use various techniques to create change.

I've heard many interesting experiences where the hierarchical desensitization didn't work and people needed other approaches that made the difference. 
You probably heard about childhood regression or "past life" hypnosis techniques. Others prefer some form of "energy balancing or raising". Those approaches can address the core emotional issue much faster (and sometimes the only thing that works). Plus, sometimes the subconscious mind may have it's own reason to maintain a habit/pattern and you have to satisfy that reason before you can replace that habit/pattern. I know this may sound strange. I used to be a skeptic but my and many others' experience "converted" me.  Of course, I'm not a preacher or missionary to convert others but at least it's good to be aware of many options to try.

So from my experience I still maintain that, unfortunately, CBT won't work for everyone.


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## Dan1987 (May 26, 2015)

I don't feel CBT has been useless to me, I've had about 8 sessions and I feel I've changed as a person as I understand my social anxiety more, I'm still booked for around another 4 sessions but I've reached a point where I know what I've got to do and don't feel like I need anymore sessions as I won't benefit. If I didn't have it I would still be stuck in an unhappy place, but I guess it's not for everyone.


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## naes (Nov 1, 2013)

Dan1987 said:


> I don't feel CBT has been useless to me, I've had about 8 sessions and I feel I've changed as a person as I understand my social anxiety more, I'm still booked for around another 4 sessions but I've reached a point where I know what I've got to do and don't feel like I need anymore sessions as I won't benefit. If I didn't have it I would still be stuck in an unhappy place, but I guess it's not for everyone.


Please elaborate as to how you think it helped you then.


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## YummyYum (Nov 7, 2015)

newbornmind said:


> Anxiety in my experience and belief is a "bottom up" process. Meaning it's a problem generated in your emotional brain. Emotions come first, and then create the negative and limiting thought patterns that anxiety sufferers find themselves in.
> 
> I think any method worth it's salt has to work from the bottom up, instead of using a "top down" approach (like CBT). So methods that work with feelings and emotions are much more powerful, and actually can stand a chance of helping people make changes IMO.


Yes. Thank you! From an evolutionary perspective, EMOTIONS are what keep us alive, not thoughts. If cognition has anything to do with it, then why do we see the equivalent to social anxiety in animals where the gamma is always trying to please the alpha??

So the EFT has been working well for you...could you please elaborate on that? What exactly is it?


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## YummyYum (Nov 7, 2015)

Caedmon said:


> :
> Optimal treatment of social phobia: systematic review and meta-analysis (Canton et al, 2012). One stop shopping for "what works".


In this article, it says "It is also important to consider how these treatments compare over the longer term. Three studies have published follow-up data on outcomes after a treatment-free period. In all three trials, the psychological treatment showed greater maintenance of treatment gains or protection against relapse relative to the drug treatments."

By that does it mean that the psychological treatment showed better protection against relapse after the treatment was over, as compared to the patients who stopped taking the drug? Seems like a stupid question I know but I feel like this would be more than obvious. How could anyone who had success with a drug _not_ relapse if they stopped taking the drug? Am I missing something?


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## newbornmind (May 6, 2012)

YummyYum said:


> Yes. Thank you! From an evolutionary perspective, EMOTIONS are what keep us alive, not thoughts. If cognition has anything to do with it, then why do we see the equivalent to social anxiety in animals where the gamma is always trying to please the alpha??
> 
> So the EFT has been working well for you...could you please elaborate on that? What exactly is it?


EFT (emotional freedom techniques) or "tapping" are gaining a lot of recognition now. In fact there's even science on pubmed behind it's validity - like this study, which showed it decreased cortisol, compared to traditional talk therapy models:

http://www.ncbi.nlm.nih.gov/pubmed/22986277

A huge amount of information can be found on youtube/google about tapping and it's benefits/applications.


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## AngelaNicholson (Dec 7, 2015)

CBT help me with my anxiety issues, its a nice therapy for treating anxiety and depression.


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## VanDamme (Jun 8, 2004)

YummyYum said:


> In this article, it says "It is also important to consider how these treatments compare over the longer term. Three studies have published follow-up data on outcomes after a treatment-free period. In all three trials, the psychological treatment showed greater maintenance of treatment gains or protection against relapse relative to the drug treatments."
> 
> By that does it mean that the psychological treatment showed better protection against relapse after the treatment was over, as compared to the patients who stopped taking the drug? Seems like a stupid question I know but I feel like this would be more than obvious. How could anyone who had success with a drug _not_ relapse if they stopped taking the drug? Am I missing something?


It's one thing to GUESS what the outcome might be (even if the guess is educated) and another to actually observe what IS happening. You can't be 100% certain what will happen until you actually do the experiment or test. Placebo effect is a good example.


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## jake272 (Feb 14, 2014)

Well the problem is that it's hard work, and not everyone is willing to go through pain and uncertainty to overcome their problems.
_Posted via Mobile Device_


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## NuthinSimple (Jul 5, 2015)

I do contract for a company that lends "aid" to Iraq war veterans. Not saying any names, but they do this therapy in house and I can pretty much vouch that it is a placebo sham. But hey if you think it works then it works.


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