# CBT is not appealing



## McMillan (Sep 7, 2009)

I know this can be very effective with medication but I know the gist of therapy is forcing yourself into uncomfortable situations (ie your fears) to help you realize your fears and thoughts are irrational.

My social anxiety was so strong from grade 6 to grade 12 I *literally* forced myself to open the front doors to the school *every day* and I wish that were an exaggeration.

I may give it a shot to get the most out of my medication, well, once I fight my right combo, but I find it hard to believe it'll help me that much. Maybe I'm wrong but I guess I'll have to see.


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## Edwin (Jun 19, 2008)

That's exposure therapy you're talking about - which can be a very bad thing for severe cases of Social Anxiety Disorder.

Although I would assume CBT uses some exposure, but with a focus on how you think and act.


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## redtogo72 (Jun 7, 2008)

Does your therapist do exposure exercises with you? There's an A&E show called Obsessed where people with OCD undergo CBT. The therapist and the patient do the exposure exercises together. Later, the patients can try them on their own. I don't remember doing this when I did CBT!

I feel like in therapy we're often left to fend for ourselves. When I was doing CBT, it wasn't like Obsessed. I had to do the homework on my own. And it pretty much only involved doing walks everyday.

I think you have to continually force yourself to do things you normally wouldn't do. I went to high school for 4 years, and rarely missed a day of school, but I wasn't raising my hand in class, talking to enough kids, or doing extracurricular activities after school. I was almost mute, and only observing others which just makes me withdrawn and over think everything.

Exposures that I'd do: before class I'd try and talk to someone, after class I'd go to the book store to look around, at work I'd talk to a coworker, etc. Without medication, it's almost impossible for me to do those things.

The problem I have is that some doctors don't like to prescribe benzos and other meds that will help me do exposure exercises. So while I was pushing myself to get out more, it was still really painful and exhausting. This only reinforced my belief that I was better off avoiding situations in which I had to be more social.


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## TheoBobTing (Jul 8, 2010)

There's also the cognitive side of CBT, which basically involves trying to pinpoint irrational thoughts that trigger or exacerbate episodes of excessive social anxiety (which can be harder than it sounds), so that you can consciously challenge them with rational thinking and replace them with alternatives that are not irrational. Think of times when you've been anxious recently and try to pinpoint what was going through your head. Practice dispelling negative thoughts with logic and reasoning, and then try to think of more rational alternatives. Then try to apply all of this in situations you find tough. 

If you're going to go down the exposure route, which is a good idea as long as you're ready, it would probably be best to expose yourself to situations that you find only slightly frightening, but to do it as often as possible. Don't throw yourself in at the deep end, or expose yourself infrequently. Do it gently, but continually. 

You may indeed need help from meds though.

This is just my amateur opinion


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## jangle1 (Jan 11, 2011)

I don't like the concept of enduring pain either, but honestly what are our options? Medications such as SSRI's work for some but not the majority, other medications are really hit or miss, Nardil is probably the best medication for SA but carries the risk of hypertensive crisis down the line.

The exposures in CBT are painful, and yes it would be nice if there was a more convenient form of treatment for our disorder. But consider the alternative, SA is painful and without adequate treatment will continue to be painful for the rest of our lives. If we're going to have to suffer pain anyway, we might as well do it for our benefit rather than our detriment.

The pain in exposures actually isn't constant, the purpose of it is so that your anxiety ratings will go down in values. That is to say that eventually the pain you're experiencing will diminish with time such that at the end of your exposure it will be half or less the values you were reporting at the beginning.

That may be a small consolation but it's the truth.


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## LALoner (Dec 3, 2008)

McMillan said:


> I know this can be very effective with medication but I know the gist of therapy is forcing yourself into uncomfortable situations (ie your fears) to help you realize your fears and thoughts are irrational.
> 
> My social anxiety was so strong from grade 6 to grade 12 I *literally* forced myself to open the front doors to the school *every day* and I wish that were an exaggeration.
> 
> I may give it a shot to get the most out of my medication, well, once I fight my right combo, but I find it hard to believe it'll help me that much. Maybe I'm wrong but I guess I'll have to see.


CBT therapists don't always emphasize exposure therapy. Changing your thinking is the usual emphasis. Thats why the name starts with cognitive.


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## TheoBobTing (Jul 8, 2010)

I think that the gradual exposure element of CBT for S.A. is the strongest part, generally speaking that is. Obviously some people will react better to the cognitive part though. CBT is all about changing one's thoughts and beliefs, and nothing quite changes those like putting yourself into new and challenging situations to basically 'explore', and gather solid experience that counters those thoughts and beliefs. However, for many people, like me, it would take a large amount of proactivity and enthusiasm to push through the difficulty and really make exposure work. I've read that exposure sessions need to be somewhat prolonged in length, otherwise you just reinforce the notion that keeping these situations brief is what prevents 'disaster' rather than learning that the situation is not as dangerous as it is thought to be.

I can't bring myself to do exposure at the moment. I'm struggling to find the motivation required. I've tried cognitive restructuring but it doesn't seem to affect how I think in a 'deep' way.


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## wxolue (Nov 26, 2008)

I was quite honestly in the _exact_ same situation you are in now. School was terribly hard on me. I entered therapy thinking that if exposing myself to anxiety was all I had to do, why hadn't 180 days of my junior year of high school done it? Why not the 180 days of my senior year? I none the less went through the therapy, and did the exposures. I can tell you that the one difference between all those painful days at school and a therapy guided exposure is that in school your only goal is to escape the anxiety. In therapy, you're trying to face it. You're trying to feel as much as you can for as long as you can. It sounds scary and a little corny, but once you get into a really good exposure, it's exhilarating. It's uplifting and inspiring. Don't get me wrong, you're feeling pretty bad anxiety, but it's different. Trust me .

The moment you become dead set on doing absolutely nothing to mitigate the anxiety is the moment you start really doing cbt.


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## senrab (Apr 23, 2006)

I see so many threads like this on this board..."CBT isn't working", "I hate CBT" etc. etc.

Want to know why it doesn't work? This is just my own personal experience. I believe that exposure therapy and changing your thinking patterns won't do it alone. It's too...what's the word...."task" or "homework" like? Which can create even more anxiety. It's too situational and results-based. You really have to go back into your childhood, how you interacted with and currently interact with your family, and search for traumatic events that you've been repressing in order to really move on. Being abnormally afraid of people is a deep, deep, deep thing. For instance, although I have shared almost all of my secrets with my therapist, there's still one thing I've never told her...2 or 3 traumatic events that happened in 4th-5th grade that I still have been unable to share with her, going on 10 years now. I wasn't abused, as a matter of fact, I've actually been cycling through my memories over and over again to try and remember if anyone was ever inappropriate with me but there's nothing I can recall. What I do know is that there is a group of pretty humiliating things that happened to me in school at a time when I was especially vulnerable due to my mother's alcoholism. I just KNOW these things are a big part of why I am the way I am, I've never forgotten them after all these years (going on 20 years). I really want to try and finally bring it up sometime this year, but the only way I think I can is by writing it out and specifying that I don't even want to name the events specifically when we talk about it...like call it "thing #1 that happened in 4th grade" or something. 

My therapist is someone who doesn't believe that these issues can be resolved in just 1 or 2 years, and I don't either. This is not a specific phobia, like heights, where all you have to do is avoid heights and you don't necessarily have to overcome that fear. This is an all-encompassing, all-consuming nightmare, because you have to interact with people on a day-to-day basis.


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## HeWhoCouldNot (Nov 18, 2010)

McMillan said:


> I know this can be very effective with medication but I know the gist of therapy is forcing yourself into uncomfortable situations (ie your fears) to help you realize your fears and thoughts are irrational.
> 
> My social anxiety was so strong from grade 6 to grade 12 I *literally* forced myself to open the front doors to the school *every day* and I wish that were an exaggeration.
> 
> I may give it a shot to get the most out of my medication, well, once I fight my right combo, but I find it hard to believe it'll help me that much. Maybe I'm wrong but I guess I'll have to see.


Actually, until you learn effective coping methods, that kind of exposure can be very damaging. Part of CBT/Mindfulness etc, is learning strategies for dealing with anxiety. You then slowly introduce yourself to anxious situations.


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## TheDaffodil (Jun 20, 2009)

The CBT program I did included much more than just going into situations that are uncomfortable. I was already in situations I was uncomfortable in, revolving around school, so some things I would have had to do anyway. And I didn't have to go into situations to know what my thoughts are. My psychiatrist would lay out a situation and I'd tell her what my immediate thoughts and feelings are or we'd talk about situations I've already been in and I'd write them down, monitoring my anxiety, and we'd really break down each thought and form specific ways for me to respond to those thoughts. And I had the medication and the journal and the sessions once or twice a week (depending on whatever is going on in school - if I had a project or graduation stuff to deal with I went in twice a week). It was very involved. Yes, I had some exposure but that's not all it was and if I ever felt like something was too much we could scale back and rethink things. We (my psychiatrist, my parents, and myself) really worked hard to get to the core of my problem and chip away at it little piece by little piece and the tools I learned there I can still use now. It was good for me.


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## Arisa1536 (Dec 8, 2009)

HeWhoCouldNot said:


> Actually, until you learn effective coping methods, that kind of exposure can be very damaging. Part of CBT/Mindfulness etc, is learning strategies for dealing with anxiety. You then slowly introduce yourself to anxious situations.


Good post and you worded it very well.
You can't be expected to just leap on into CBT like this terrible social anxiety support group i went to where most of the people were terrified of leaving the front door, the first thing they had us do was walk down a crowded city street and cross heaps of busy roads, it was noisy, people honked at us and aside from me and one other girl most people did not return to the group due to that intensely anxiety provoking experience. I do not know what type of therapy that is, possibly *fight or flight?*

Actual CBT is effective when combined with medication
Without medication i think its impossible, unless you are extremely motivated and able then good on you and you are a much stronger person than I am because i tried CBT before going on Effexor, i was just on Paxill (Arapax) and i could not do it, the thought processes and challenging our behavior patterns and all that cognitive stuff was beyond me and i found it boring listening to the psychiatrist and other social worker there talking about it because i wanted to run out and drive home But on decent medication (Effexor and lorazepam and zopiclone to sleep) CBT was great and i was able to do my best to put it into practice but like all therapies its not a miracle cure. Reading the text books they give u is helpful and writing down your fears and irrational answers compared to the rational answer of each question you write down for yourself was good too, therapeutic in a way


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## AlekParker (Oct 31, 2006)

The Dr Richards tapes are based on CBT if u want to try it at home before seeing someone.

Also there are some good books like the Shyness and Social Anxiety Workbook if you want to learn about it. But it's hard to do it on your own unless you're super motivated which can be hard when you have SAD or depression.


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