# CBT - does it work, is it over rated?



## UKguy (Sep 30, 2013)

I'm finding it hard to buy into CBT even though I get on OK with my therapist.

I had 4 sessions so far and I just find it hard to get the energy or motivation to do the homework tasks. I understand the whole behaviour-thoughts-feelings cycle and think there is some truth to it, but at the same time I just feel like it is really superficial. 

I can change my behaviours which might make me happier for a while but it doesn't address the underlying **** does it? It just seems like glorified positive thinking, I mean who decides what is a distorted or unrealistically negative thought; who is truly objective on that? 

I feel like what I want more is someone to talk to and to provide a bit of support and guidance, more like a mentor or even a friend. 

I wonder if maybe CBT is more useful for tackling a specific phobia, rather than generalised anxiety and chronic moderate level depression? Or maybe I need to give CBT more time?

Any thoughts or suggestions please help...


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## Just Lurking (Feb 8, 2007)

When I first did CBT, I was like "eh" (I didn't really believe in it), but I came to see the value in it. For me, it's not curative by any stretch, but it's helped at times, and I welcome any improvement.

My first CBT sessions were one-on-one, but I got nowhere with that. Personally, I found group CBT to be most effective. A group setting allows you to hear insight from other patients and listen to therapist feedback given to others in the group. I've picked up a lot of pointers in group settings.

I'd suggest giving it more time and practice (more than four sessions) and looking for signs of *any* improvement (however small and fleeting it may be). Even if you bring your anxiety level down from a 75 to a 70, that's an improvement, and it's a sign that more progress is possible.


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## MadnessVertigo (Sep 26, 2016)

I have the same feelings as you about it... that it is glorified positive thinking, and kind of patronizing in that it places the therapist in a position of teaching you objective reality that you are supposedly too emotional to grasp. I've never given it a fair shot though and don't wish to discourage you from doing so. But there are competing treatment modalities... stuff like memory reconsolidation, primal therapy, EMDR. Wouldn't hurt to at least research what is out there. 

I wish I could find the posts on this forum someone made about memory reconsolidation. They recommended some books, one of which is called the Archaeology of Mind. It's a giant tome but really interesting read... it attacks the idea that treatment for mental pathology should be "top-down", i.e., higher cognitive brain controlling lower animal brain. The author is a neuroscientist that studies animals, and he posits that we should instead recognize the lower brain as the driver of mental health or illness, and more work needs to be done on how to treat it, or else all the cognitive fiddling is for naught. I hope I'm not digressing and butchering paraphrasing the book, but I guess the point is that CBT does have reputable critics as in not the only game in town.


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## truant (Jul 4, 2014)

Yes, it works. CBT is healthy thinking. It's a lifelong process, like healthy eating and exercise. You don't do it a few times and decide it doesn't work, just like you wouldn't eat a few healthy meals, or exercise a few times, and decide that diet and exercise don't work because you didn't notice an immediate improvement. (But like diet and exercise, CBT won't cure everything. You can't regrow a lost limb with diet and exercise, and you can't fix certain kinds of mental issues with CBT.)

But your skepticism is quite normal because CBT is rarely properly explained (or even understood, it seems) by many therapists. And it is much more effective for solving certain kinds of problems than other kinds of problems. Most of the people on this forum aren't suffering from an abrupt case of SA but a longstanding, even lifelong condition. That means that their problems are much more difficult to fix because the anxiety has basically become part of their personality. (Imo, chronic SA is a personality disorder.)

Let's look at some examples.

1. You are required to give a presentation at work. You are anxious about giving it, it doesn't go well, and people criticize your work. Suddenly, you experience anxiety at work, whereas you didn't before; you think everyone is questioning your right to be there. It starts to overflow into other aspects of your life. You start to wonder if your wife really does respect you, if your friends really do like you, etc., and you start avoiding interacting with people. This is an example of how someone could develop SA later in life, much as someone might develop depression later in life.

This is the sort of problem that CBT is very effective at correcting, and the reason why it's effective is that the disorder hasn't had a chance to take root in your personality: at this point, you are questioning whether or not you are a failure, you haven't identified AS a failure. You have all kinds of prior successes on which to draw that prove that you are not a failure. So it's easy for a therapist to help you see that this one failure does not define you as a person, and that it does not mean you are bad at your job, a bad husband, etc. It's an isolated incident which has spiraled out of control. This is the sort of problem that those short 6 week CBT interventions can actually solve.

Now let's look at a typical example of the sort of person that becomes a regular here:

2. You have always been ignored or treated badly by other people. This treatment leads you to draw the conclusion that you are somehow inferior to others; that you are less intelligent or competent or lovable or attractive or whatever. This leads you to avoid interacting with people to avoid shame and embarrassment. While all your peers are making friends, getting gfs/bfs, getting jobs, moving out of the house, etc., you're still stuck in the same place, because you're too afraid of being publicly humiliated to interact with other people. This is an example of chronic, lifelong SA.

This is the sort of problem that is much, much harder for CBT to correct. I DO believe that CBT can correct even this sort of problem, but it's not an easy or direct solution. It basically requires you to completely transform yourself. And the reason is that your SA is rooted in your self-concept. You identify AS a failure or loser, etc., and you've spent your whole life amassing "evidence" that you are one. Your self-concept directs your behavior, so if your self-concept is that you are a loser, then you will act like a loser and perpetuate your condition. The only way to correct this is by rejecting the evidence that you've accumulated, rejecting the identification as a loser, and working to amass new evidence that supports a new sort of identity.

A short 6 week CBT intervention with a therapist isn't going to scratch the surface of a problem like this. It takes a lot of insight and work to reorient your self-concept in a new direction. It is NOT positive thinking. Anyone who teaches CBT as positive thinking is not teaching CBT.


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## WillYouStopDave (Jul 14, 2013)

I think brainwashing works on some people but obviously not everyone. At least not yet.


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## UKguy (Sep 30, 2013)

BTW I should add I have done CBT before many years ago and it was helpful for getting over my total agoraphobia, however I did hit a brick wall in terms of progress.

So for me it isn't all about social anxiety; I was hoping to perhaps address past issues, gain some self acceptance and work on my depression.

The issue I think I have had with CBT is it seems to force everything into a model of - something happened and you felt bad - reason being your thoughts interpreted it incorrectly.

Never is the reason why you interpret things in a "distorted" way and experience so much self blame examined. In a way it is like what many people consider to be the symptoms of depression are in fact treated as the cause of depression in the CBT model... which is almost circular logic?

@truant
I think what you are describing is much more as I see CBT as being good at - managing specific situational phobias. I think my problems would fit more into category two... life long and almost intertwined with my personality at this stage. Not just the SA but the depression as well.


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## Just Lurking (Feb 8, 2007)

UKguy said:


> Never is the reason why you interpret things in a "distorted" way and experience so much self blame examined. In a way it is like what many people consider to be the symptoms of depression are in fact treated as the cause of depression in the CBT model... which is almost circular logic?


There are two different therapies going on here -- one is psychotherapy and the other is cognitive behavioural therapy. (_"Psychotherapy" is an umbrella term which would include CBT, but for purposes here, it's in reference to "standard talk therapy/counseling" -- basically the kind of therapy seen depicted in TV and movies._)

With psychotherapy, the counselor is the therapist, and it would, in part, entail exploring the root of your problems. This therapy can go on indefinitely.

With CBT, you are your own therapist, and the counselor is just there to teach and provide guidance to get you capable of doing it on your own. This therapy is a structured, time-limited program.

You can do CBT in psychotherapy, but doing psychotherapy in CBT would be a distraction that takes up valuable time meant to be used towards developing and improving coping skills.


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## truant (Jul 4, 2014)

UKguy said:


> I think what you are describing is much more as I see CBT as being good at - managing specific situational phobias. I think my problems would fit more into category two... life long and almost intertwined with my personality at this stage. Not just the SA but the depression as well.


The talk therapy part of psychotherapy that @Just Lurking is talking about is really just more involved CBT. (Psychotherapy itself is broader than talk therapy, though, and includes a lot of other techniques.)

All talk therapy is ultimately about reframing the data you have available (ie. reinterpreting it), and CBT works by forcing you to be more critical of the data you accept, and being smarter about the way you interpret it. When you have more accurate data, you can reframe your situation in a more accurate (and therefore healthier) way. People with damaged core concepts typically need the help of a therapist because they often don't even know what a healthy core concept looks like.

Psychotherapy differs from CBT in that additional techniques are typically employed in order to increase the amount of data that you have available because you don't have enough data available to consciousness. That's where things like dream interpretation, free association, hypnosis, role-play, bodywork, etc., etc., come into play -- more data, more accurate (and healthier) self-concept. That's the theory, anyway.

A person with chronic SA typically has an unhealthy self-concept/world concept; it's that concept that serves as the source of all of the negative thinking. Using the kind of standard self-help CBT they teach you to counter that is like trying to keep a ship with a leak floating by using a bucket. The only way to stop those negative thoughts from being continually repeated is by plugging the actual hole, which is in your self/world concept.

The type 1 patient I described above is like someone who has a healthy self/world concept, but has been in a storm and taken on water; in that case, the bucket will work. You just have to keep slogging along until the water is gone. But a type 2 patient is someone with a leak. Those negative thoughts will continue to arise until the leak is plugged; if you use the standard CBT bucket your arms will fall off long before you even find the leak. A bucket isn't good enough. That's why ordinary CBT doesn't seem to work, and why so many people here (long-term SA sufferers, mostly) dismiss it. But it's not that the technique doesn't work, but that it's not being applied to the right level. You're skimming your thoughts off the surface instead of sticking your head in the water to find the hole.

A person with chronic SA typically has self-concepts like: "I'm worthless", "No one likes me", etc. These self-concepts often appear in your ordinary thoughts in some form and are _superficially_ the same thoughts that a person with type 1 SA might have. But they're different, because in this case, they're not passing fears and worries -- they're part of your core concept; and unlike a type 1 person, who has lots of evidence that "no one likes me" isn't actually true (because they have friends, family, etc.), a type 2 person has lots of evidence that "no one likes me" IS true -- because they've spent their whole life amassing evidence that proves it, unlike the type 1 person who has just started looking for that kind of evidence. (I have a friend that likes to torture themselves by reading self-help articles online, and almost all of these articles are targeted at people in the type 1 category. The articles suggest helpful things like: "When you feel like nobody likes you, just remember that your friends and family love you..." Lol. They're all written by neurotypicals.)

The problem isn't that CBT doesn't work on a type 2 person, it's that a type 2 has to have a much better understanding of the relationship between concepts, expectation, perception, cognition and identity so you know how to build a new self-concept from the ground up; you don't have the history of success and counter-evidence that a type 1 person has accumulated. You have nothing to work with, so you have to open your own mental shop and start manufacturing parts. You can't "go back" to being healthy if you were never healthy in the first place.


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## 546617 (Oct 8, 2014)

cbt is basically brainwashing like the previous guy stated only dumb people will succed with it. if your social anxiety/depression is a chemical imbalance no amount of therapy will do anything.


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## UKguy (Sep 30, 2013)

truant said:


> The talk therapy part of psychotherapy that @Just Lurking is talking about is really just more involved CBT. (Psychotherapy itself is broader than talk therapy, though, and includes a lot of other techniques.)
> 
> All talk therapy is ultimately about reframing the data you have available (ie. reinterpreting it), and CBT works by forcing you to be more critical of the data you accept, and being smarter about the way you interpret it. When you have more accurate data, you can reframe your situation in a more accurate (and therefore healthier) way. People with damaged core concepts typically need the help of a therapist because they often don't even know what a healthy core concept looks like.
> 
> ...


In your reply you use terms like reframing, reinterpreting, using more accurate date and so on.... 
but this is kind of my point I guess... who decides what is accurate and what is distorted? Where is the guide to what is negative thinking and what is just plain realism? Where is the guide as to what healthy "rational" thinking looks like...

If I have a thought about my life that makes me feel really low because "I've failed" - I examine that thought and the core reasoning behind it is because I can never achieve my dream career aims. Going into more depth it is because I lack the social skills, physical health, finances, education, and lots of other hurdles which would be nearly impossible to climb. To my mind this not a distorted or unrealistic thought that is making me feel bad, it is the cold hard facts of life.

Oh the other hand if I were a school kid and I dropped my books in front of class and my first thought was _"OMG, I'm such a loser, everyone now thinks I am a clumsy useless freak" _- well that is a lot easier to see how CBT techniques might help there.


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## truant (Jul 4, 2014)

UKguy said:


> In your reply you use terms like reframing, reinterpreting, using more accurate date and so on....
> but this is kind of my point I guess... who decides what is accurate and what is distorted? Where is the guide to what is negative thinking and what is just plain realism? Where is the guide as to what healthy "rational" thinking looks like...
> 
> If I have a thought about my life that makes me feel really low because "I've failed" - I examine that thought and the core reasoning behind it is because I can never achieve my dream career aims. Going into more depth it is because I lack the social skills, physical health, finances, education, and lots of other hurdles which would be nearly impossible to climb. To my mind this not a distorted or unrealistic thought that is making me feel bad, it is the cold hard facts of life.
> ...


You decide what is accurate and what is distorted. It can't be any other way. A good therapist will try to show you where they think your thinking is wrong and why it's wrong. It's up to them to convince you, and it's up to you to listen with an open mind. A bad therapist will just tell you what to think and expect you to go along. But if you don't believe them, it won't help, will it? You'll just think they're bull****ting you. So it's always up to you, whether or not anyone else gets involved.

CBT is never (or shouldn't ever) be about trying to convince yourself of something that isn't true. It's not about pretending that things are better than they are; in fact, people who are delusionally optimistic need CBT to correct their delusions, just like people who are delusionally pessimistic. CBT should always be about thinking more clearly and accurately.

This is a huge topic, and I clearly can't psychoanalyze you over the forum, so let me give you an example that might apply to anyone:

John has the belief: "No one likes me." This is part of his self-concept. He is a person who has never met anyone who likes him.

There are three basic ways you can interact with another person: you can be mean, you can ignore them, or you can be nice.

If someone is mean to John, he thinks: "See, that person doesn't like me."
If someone ignores John, he thinks: "See, that person doesn't like me."
If someone is nice to John, he thinks: "That person doesn't _really_ like me, they just want something."

This is a closed circle. No matter how any other person reacts to John, John's belief that no one likes him remains unchanged. With this belief, he will continue to accumulate more and more "evidence" that no one has ever liked him. Every person that is mean to him or that ignores him confirms his belief, and anyone that is nice to him is reframed (interpreted) in a way that is consistent with his belief about himself.

Apply this to anything you believe about yourself. Let's say that I have the belief: "I am much smarter than most people."

If I win an argument, I think: "See, I'm smarter than they are."
If an argument has no clear winner, I think: "I'm right, they just don't know it."
If I lose an argument, I think: "Well, I'm still right, I just have to come up with a better argument" or any of a million other rationalizations.

It's very, very hard for people to be objective about their experiences. You shouldn't trust ANY one-dimensional explanation for a situation. Intelligence isn't about finding the one right way of interpreting something; it's about being aware of all the possible interpretations and keeping them in mind. A one-dimensional thinker is rigid and resistant to change; a multidimensional thinker is flexible and adaptable. But most people have very rigid either/or thinking patterns. A person either likes them OR wants something from them. Since it's always possible to find some kind of advantage from pretending to like someone (maybe they're just being polite, or they're bored, or they're lonely, etc., etc.), it's always possible to dismiss the possibility that another person really likes them. One-dimensional thinkers find it impossible to understand that a person can both like them AND want something from them.

And this is the way most of the "evidence" that we have about our own lives is built. It's based on these closed circles that always interpret data in the same way. It takes a LOT of hard to rationalize-away experiences to shake a person's self-concept. And many of the people on this site developed these negative core concepts very early in life and have spent decades accumulating evidence that "proves" them. They've been acting as if those core concepts are "reality" for so long that they might as well be reality.

"Positive thinking" is (or should be) about finding what is actually good about an experience and acknowledging it and taking advantage of it. That doesn't mean denying that an experience was also bad (and maybe a whole lot more bad than good); it's not about self-deception; it's about doing the best you can with the experiences that you actually have.

Example: It's true that being single sucks; but it's ALSO true that being single gives you certain kinds of freedoms that you don't have when you're in a relationship. That doesn't mean you shouldn't want a relationship and try to get one, only that you should take advantage of the good things you can experience while you are single. Positive thinkers tend to be happier because they're paying more attention to the good parts of their experience and less attention to the bad parts. If you pretend that the bad parts OR the good parts of an experience don't exist, you're delusional. A "realistic" thinker is a person who is aware of all the significant dimensions and interpretations of their own experiences.

This is all CBT, it's just a more advanced form than the kind they teach you in brief therapy.


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## JohnnyBoy55 (Aug 16, 2017)

I tried CBT a couple of years ago with my therapist and it didn't work. Possibly as I didn't see it through to the end, at the time the tasks I was given to do as homework were just too overwhelming and so I chickened out. Maybe it just wasn't the right time for me.

Then a few months I was so pissed off with my social anxiety, I'd had enough and so decided to give it another try on my own (I was no longer seeing the therapist).
I started off doing smaller things such a visiting smaller shops to buy groceries instead of just buying online (I still couldn't face supermarkets at this point) and I'd go at times when I knew it would be the least busy. Eventually I was brave enough to visit supermarkets which was really tough (I'd go early or really late when it was the least busy), and I just built on it from there.
I still can't do away with the safety behaviors though, and I need my phone to bury my face into if things start getting tough. Eventually I started forcing myself to look up at people as I was walking around instead of walking with my head down looking at the ground or looking at my phone constantly, and I realised that nobody was actually looking at me...they were all too busy getting on with their own day-to-day lives!

Then a few months ago I decided to throw myself into something that would completely put me outside my comfort zone and joined a martial arts school. Yes it was very scary and before hand my mind was crazy with all the usual negative thoughts, and I almost didn't go through it. It completely took all of my courage to drag my *** to the first class. I was so anxious when I stepped through the door for the first time that I honestly thought I was going to have a heart attack. In actual fact I had a great time and loved it!

I'm not saying CBT cured me or made the social anxiety completely go away, as I do still suffer with it every day, but I feel as though I'm no longer a prisoner in my own house. If I hadn't have given CBT another try there is no way I would've been able to to join the martial arts school. I still feel anxious before I leave the house to go to a class, and I almost talk myself out of it... but once I'm there having a great time (and the people are really friendly so that helps) I often wonder what all the fuss was about and why I was making such a big deal of things in my mind.

Anyway, enough rambling. That's just my thoughts and experience on CBT. I would say it_ can_ work but it's a slow process and can be really tough to do the scary tasks. Be brave though and persevere, you'll be glad you did


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## Thejoke (Oct 7, 2016)

c*ck and ball torture? doesn't sound too effective to me.


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## VanDamMan (Nov 2, 2009)

It works. It does take time to rewire your brain though.


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## SFC01 (Feb 10, 2016)

I think if you are on the road to recovery already due to medication or a change in fortunes or whatever then it can play a part in getting and staying better but I dont have too much confidence in it if you are at rock bottom mentally.


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## marsia (Mar 22, 2016)

I agree with truant and really find his distinction between a short term SA episode and anxiety constantly messing with identity really helpful. My husband went to a CBT group for SA because he worked for a cut-throat firm and he needed to do do public speaking, and had a little nervous breakdown. The group was very helpful and he was cured. For me, who has always doubted myself and who has always felt like an outsider to society, exposure therapy is really necessary so I don't isolate and become depressed, but it doesn't touch the feelings of not fitting in or not being confident enough to be myself.

I also had PTSD from early childhood, and cured it with talk therapy (existential was most helpful) and not believing the hallucinations and soothing myself through the flashbacks (which I learned to do myself.) I have a master's degree in transpersonal psych and an emphasis in art therapy and did 150 hours of working with clients, which I loved so much. I didn't get my license though (long, not relevant story.) I can tell you that psychology is an art and that there are many practitioners stuck in unhelpful paradigms (like replacing your set of thoughts that aren't working for you with theirs or with brain-washy positive thinking) who don't even know it. Many of my fellow trainees were much less psychologically aware than my clients, and many were completely unquestioning of the dominant paradigm that leads to a lot of stress and lack of self acceptance in many, many people. We have an epidemic of depression and anxiety in the society, and mainstream psychology is not addressing the cultural influences of this. So that's my background in a very condensed form.

That said, what I am finding helpful for addressing the lack of self acceptance is a sub-field of Buddhist psychology called self compassion. There is a lot on this online if you are interested. My favorite book so far is called There Is Nothing Wrong with You: Going Beyond Self-Hate by Cheri Huber. Here is an excerpt: 
"Not wanting to be how you are is one of the most significant aspects of self-hate.

We have been taught to believe that it's not okay to feel what we feel or think what we think or have the experiences we have. As children, people didn't like us when we did that so they tried to change us. We've internalized that, and we've taken on that system ourselves. So now we're trying to change everything we don't approve of.

In acceptance, we don't want to change those things about ourselves. It's only in non-acceptance that we hope acceptance will mean that they change.

We can have the full range of experience 
that is our potential, 
and we can enjoy it all.

If we move through and beyond that conditioning to change, then everything is available to us. For example, if you're miserable, there's nothing really wrong with that, but if you're hating being miserable, then it's hell. If you're miserable and not hating it, you'll probably move through it pretty quickly.

Experiences do move along quickly when we're present and not resisting. It's when we stop being present and get stuck in something that we can drag it out forever. 
We are never going to "get" something 
a philosophy,
a formula,
a fixed point of view 
that will make us forever different (pp. 82-83.)"

I write to a few people on this site and we support each other with SA if you ever want to PM me. Or I would love to just hear what you think of this in this thread, if any of what I wrote seems helpful or not.


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## UKguy (Sep 30, 2013)

7 or 8 sessions of CBT and I don't really feel any progress or and little motivation to continue. I don't really understand what the plan is or how this is helping me... I mean I understand the concepts introduced so far but still....

Anyway, I feel things have not really progressed beyond filling in a weekly diary of my activities and mood and then the therapist picking out any little ups or downs to support their theories or model. I have good days and I have **** days and I have lived with this long enough to believe there is little rhyme or reason behind it.

I do have some breathing exercises which I am supposed to be doing daily but I find hard to do, both in terms of doing them and in terms of wanting to do them.

Behavioural activation is something that has been talked about but how does one keep that up when there is so little enjoyment in anything. I try doing things and sometimes feel better for a while, sometimes feel significantly worse and most of the time feel nothing much at all changes.

A lot of what has been covered in CBT so far reminds me of a politician trying to put a positive spin on ****ty events even when everyone can see reality with their own eyes.

@truant - isn't CBT supposed to have clearly defined goals or a plan? Also I feel like I want to talk about **** memories from years ago not just dismiss it as "not in there here and now". I'm in a cynical mood today but really, I don't see how a load of low level psycho education given to me by my therapist is helpful to my situation. I could print that stuff off the internet for myself.

@marsia
Do you not find that book hard to read? I looked it up on Amazon kindle and it is all in a crazy font.


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## marsia (Mar 22, 2016)

UKguy said:


> 7 or 8 sessions of CBT and I don't really feel any progress or and little motivation to continue. I don't really understand what the plan is or how this is helping me... I mean I understand the concepts introduced so far but still....
> 
> Anyway, I feel things have not really progressed beyond filling in a weekly diary of my activities and mood and then the therapist picking out any little ups or downs to support their theories or model. I have good days and I have **** days and I have lived with this long enough to believe there is little rhyme or reason behind it.
> 
> ...


I really think you should consider existential and/or humanistic therapy. They address your relationship with yourself in the bigger picture of life and help you figure out who you want to be on your own terms, whereas a lot of mainstream therapy is concerned with helping you be "well adjusted", not self aware. It sounds like your current therapist is very formulaic, and isn't addressing you as a person.

Yeah, the book is in a weird font meant to simulate handwriting. The style of the book is like short letters to a friend, so you don't read a lot each day anyway, Each couple of pages needs to be thought about a lot in order for you to get a lot out of the book. It's meant to stimulate contemplation and deeper exploration of what we've been taught to do to motivate ourselves that actually backfires and causes a lot of self sabotage. Maybe explore "self compassion" on the web and see if you are interested in it so you know whether the book will address what you are hoping to find.


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## relm1 (Sep 13, 2016)

CBT and exposure therapy should be considered as tools to add to your tool chest when dealing with SA. The less tools you have the less options you have on how to have a normal and productive life. That does not mean it solves your SA or that it isn't beneficial. I found both to be very helpful and certainly improved my SA which is still there. I am just not crippled by it like I used to be because of CBT, Exposure Therapy, SA Group Therapy, psychotherapy, and in more extreme situations medication. I have a lot of tools in my tool chest and I still have SA.


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## Nadiareine12 (Aug 16, 2017)

I strongly suggest ACT ! It helped me more than CBT!


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## relm1 (Sep 13, 2016)

Nadiareine12 said:


> I strongly suggest ACT ! It helped me more than CBT!


It isn't one or the other though. They compliment each other. I used ACT to achieve better results with CBT so I am a bit confused by your statement.


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## Nadiareine12 (Aug 16, 2017)

Euh I don't know I did ACT without cbt!
And I was cured thank god
Cbt didn't work for me!


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## SorryForMyEnglish (Oct 9, 2014)

I've heard it only works with reducing symptoms like anxiety or things like that that lie on the surface, but it's not working with the cause. If you want a quick result and nothing really bothers you aside from anxiety then it will give you what you want and it's said to be effective for that, but nothing beyond that.


UKguy said:


> BTW I should add I have done CBT before many years ago and it was helpful for getting over my total agoraphobia, however I did hit a brick wall in terms of progress.
> 
> So for me it isn't all about social anxiety; I was hoping to perhaps address past issues, gain some self acceptance and work on my depression.
> 
> ...


I've heard psychodynamic therapists can be effective with that. It's usually quite a long-term therapy (can be from one to several years) and it focuses on your past as well as on your present and underlying issues of your depression and anxiety. Or some therapists that use CBT only as additional tool in their therapy, not as main one. This is the video I posted here some time ago: 



 Maybe that's what you're looking for? Long term non-CBT therapy, I mean.


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## UKguy (Sep 30, 2013)

Well at the moment I feel I have had some positive benefits from therapy, if only because I am being a bit more mindful and noticing when I do have positive moments during the day.

In the course of depression it is very hard to do that because everything just seems so ****ty. Progress is small and slow though, but I guess you cannot cure 15 years of depression and anxiety overnight. 

Right now I'm not even sure what we are doing is CBT any more. My therapist seems to have thrown in a few different things and we are not rigidly following any plan or schedule like CBT I have experienced in the past. 

It still isn't tacking past issues though... seems more like brushing them aside or under the carpet which does worry me somewhat. 

I just started Parnate as well, so I don't know how much of my mood boost is from that. But if my mood continues to improve I feel I might be able to use some of the CBT tools more effectively.


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## Yer Blues (Jul 31, 2013)

Exposure has done more for me. Oh, and massive amount of drugs.


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## SplendidBob (May 28, 2014)

I rate the exposure / behavioural part, combined with whatever the **** psychotherapy my therapist uses on me. The issue I have always had is that you can't just magic up motivation in someone to do the homework, since low motivation is obviously part of depression. It's basically amounting to "to do the CBT to fix depression, you have to be not depressed enough to do the homework". That obviously wont work if the depression has a motivational side.

"You get out of CBT what you put in" works great in a dualistic brain where someone can just pop outside of their biology and force themselves to do it. The patient has some responsibility (and its really difficult to draw the line where that is, been there done that in therapy ), but it's the therapists job to somehow motivate the patient to comply. Simply stating "do the homework" isn't going to work. Personally I have never been able to to the cognitive part. Tried, it didn't make a dent against my rampaging brain. Probably didn't try hard enough, but my "try hard enough" was compromised. Behavioural, just doing actions, fine.

@truant since I don't want to ask her and sorta ruin it (until the end), my therapy seems to consist of talking about stuff until I get to a sore spot. My therapist jumps on that and I expand on it, then she sorta guides me into thinking about it in a better way, or something. She might be doing other stuff too, but that seems to be the gist of it. What flavour of therapy is this?

The bizarre thing about my therapy, in the earlier sessions I used to feel I had a "fuzzy / buzzy brain" coming out of it. Very strange sensation.


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## truant (Jul 4, 2014)

splendidbob said:


> since I don't want to ask her and sorta ruin it (until the end), my therapy seems to consist of talking about stuff until I get to a sore spot. My therapist jumps on that and I expand on it, then she sorta guides me into thinking about it in a better way, or something. She might be doing other stuff too, but that seems to be the gist of it. What flavour of therapy is this?


That's not much to go on, but it sounds like standard psychotherapy. Reframing is common to most talk therapies. Most therapists are pretty eclectic, though, so you might not even be able to pin it down to a single "school".

When you say "a sore spot" do you mean a current problem you're having or something that happened when you were young? And when you say "guides me" do you mean a standard reframe or something else, like guided imagery, role-playing, etc.?

There are hundreds of different types of therapies. Most brief therapies are about solving current problems and ignore your history. Most depth therapies analyze your childhood.

Brief, solution-oriented therapies (CBT, ACT, exposure, etc.) are popular these days, but I'm actually beginning to think some problems (eg. personality disorders, lifelong depression/anxiety) do require an analysis of autobiographical history. Because your identity is based not only on your current behaviors, but your accumulated experiences.

Early-onset disorders require a lot more depth than late-onset because most of the serious thought distortions have had a lot of time to accumulate corroboratory evidence through selective attention, and that evidence is very difficult to discount. It's one thing to show a person why their current feeling of worthlessness is irrational and another to show them why feeling like they were worthless was a logical conclusion for a child to draw from the treatment he/she received from their parents, and how that conclusion has shaped their entire life history through confirmation bias and personality formation.

You have to take people back to the point where they made the mistake so that they actually see that it _was_ a mistake. You have to undermine their negative self-concept at the root. If that original mistake lies hidden, it's just going to keep producing feelings of worthlessness because it shapes all their perceptions. It's the leak in the boat.

Late-onset depression/anxiety is usually a response to a recent crisis; that crisis casts doubt on a person's identity, but that doubt hasn't yet consolidated AS their identity. They're still "questioning". Brief therapies can dispel that doubt before it has a chance to take root by reminding a person of all the contradictory evidence they accumulated before the crisis. But if you've had anxiety/depression for decades, and have a giant treasure-trove of negative experiences stored up, good luck with brief therapy. You've got your work cut out for you.


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## thistlehammer (Oct 5, 2017)

truant said:


> That's not much to go on, but it sounds like standard psychotherapy. Reframing is common to most talk therapies. Most therapists are pretty eclectic, though, so you might not even be able to pin it down to a single "school".
> 
> When you say "a sore spot" do you mean a current problem you're having or something that happened when you were young? And when you say "guides me" do you mean a standard reframe or something else, like guided imagery, role-playing, etc.?
> 
> ...


I know I'm a stranger, but I just want to jump in here and thank you for this explanation - my problems began before any solid childhood memories, and I've never seen the difficulty I've had with brief therapies documented so clearly before (I've tried, but I'm nowhere near this succinct or educated). When I was younger I had a lot of self-hatred for my inability to respond to therapies people kept insisting should work, but I've become a bit more critical as an adult. I can't seem to find anyone in my city that will take an approach other than CBT, not specifically with me, but just in general. I've been offered something called schema therapy which was explained to me as a depth therapy, but I can't afford it, unfortunately.

My partner is interested in psychological ethics, and we've had some discussions about how CBT is employed pretty broadly in a kind of questionable manner. A bit like a trend in the field? I'm not sure, but I thought it was interesting.


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## SplendidBob (May 28, 2014)

truant said:


> That's not much to go on, but it sounds like standard psychotherapy. Reframing is common to most talk therapies. Most therapists are pretty eclectic, though, so you might not even be able to pin it down to a single "school".


 Probably the case with my psychologist.



truant said:


> When you say "a sore spot" do you mean a current problem you're having or something that happened when you were young? And when you say "guides me" do you mean a standard reframe or something else, like guided imagery, role-playing, etc.?


Well its usually a current problem, but that might involve when I was younger (though not childhood, teenager - early adult was where my problems kinda started piling up. Obviously my parents parenting was **** because like most other parents they neglected to bother to learn about it, somehow believing good parenting to be a genetically learned skill, or something, but we haven't really delved that much into childhood tbh). Re guiding, its sorta asking me questions so that I come to the conclusion about it she wants me to come to, but because its me saying it, its mine . She does just sometimes say though now, because I can take it on board well.



truant said:


> There are hundreds of different types of therapies. Most brief therapies are about solving current problems and ignore your history. Most depth therapies analyze your childhood.
> 
> Brief, solution-oriented therapies (CBT, ACT, exposure, etc.) are popular these days, but I'm actually beginning to think some problems (eg. personality disorders, lifelong depression/anxiety) do require an analysis of autobiographical history. Because your identity is based not only on your current behaviors, but your accumulated experiences.


No childhood stuff really, but its definitely historical sometimes (see my acne or whatever, went into some painful / embarassing memories of those times). So an example would be, we talked about an event which I was ashamed about, but that someone did to me, in a sortof jokey way, drunk. But obviously my reaction to it was important, so she kinda got me to expand on that and then related that to a current scenario. But that stuff was pretty much the party I was going to go to and it was in the same place we used to go, had a lot of bad memories, so we explored those, and kinda hooked it up to me wanting to go to this one (but also not wanting to). Pretty much in a nutshell, I got treated like absolute **** re my appearance back then (really nasty stuff said and done), I wanted to go this time to basically show them me now, and give them the finger. But, meh, they have already seen me on FB now, so no point (the woman who's party it was I never liked and still don't). Hardly anyone ended up going, so that amused me. I came out of that session basically wanting to jettison most of the friends I had from back then, because most treated me like ****. Pretty major shift in perspective.



truant said:


> Early-onset disorders require a lot more depth than late-onset because most of the serious thought distortions have had a lot of time to accumulate corroboratory evidence through selective attention, and that evidence is very difficult to discount. It's one thing to show a person why their current feeling of worthlessness is irrational and another to show them why feeling like they were worthless was a logical conclusion for a child to draw from the treatment he/she received from their parents, and how that conclusion has shaped their entire life history through confirmation bias and personality formation.


Yeh, though like I say its not based on childhood, it's very much trimming and prodding those kinds of deep inbuilt distortions. Like at one point in the therapy I realised "holy ****, I do want all of this stuff, really, I was just convincing myself I didn't because I felt I couldn't get it". Then at this point I can start to plan how exactly I might be able to get the things I want. Fox and the grapes. 15 years or so of believing this lie I told myself. Pretty major.



truant said:


> You have to take people back to the point where they made the mistake so that they actually see that it _was_ a mistake. You have to undermine their negative self-concept at the root. If that original mistake lies hidden, it's just going to keep producing feelings of worthlessness because it shapes all their perceptions. It's the leak in the boat.


Yeh, this makes sense.



truant said:


> Late-onset depression/anxiety is usually a response to a recent crisis; that crisis casts doubt on a person's identity, but that doubt hasn't yet consolidated AS their identity. They're still "questioning". Brief therapies can dispel that doubt before it has a chance to take root by reminding a person of all the contradictory evidence they accumulated before the crisis. But if you've had anxiety/depression for decades, and have a giant treasure-trove of negative experiences stored up, good luck with brief therapy. You've got your work cut out for you.


Yup. I have up to a year, probably 3 months left. I don't think it will be enough. Short term CBT wouldn't have been able to touch this stuff.

Ty for your response tru, helpful as always


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