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Nadia

Cognitive Behavior Therapy (CBT) for anxiety, depression, and withdrawal symptoms

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Patience   
Patience

I read (most of) Dr. David Burns' Feeling Good. I also took courses in depression and anxiety management prior to going off A/Ds the last time. I gleaned from all that the triple column technique (in Dr. Burns' book), but I customized it a bit. What I do when I'm in a funk that I can't get out of is I get out my journal and write down:

 

  • The situation
  • My feelings
  • My thoughts
  • The cognitive distortions in my thoughts
  • Then I rewrite my thoughts in a more rational manner

It seems that when I've finished step four, I can see how my thinking is wrong and that's usually enough to pull me out of my funk. I think you're also supposed to rate your feelings before the exercise, then after it. That's supposed to help you see if the CBT is working. It usually does for me, so I skip that part.

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brighteningup   
brighteningup

Hi Nadia,

 

I've had issues with anxiety for other 30 years, it started when I was around 6. (Fortunately no-one ever tried to medicate me for it, and I refused medication for many years as an adult - instead I've had a range of counselling instead, some of it CBT based.

 

I've used thought challenging very successfully, I used to write them down much as Patience describes but now can usually just do it in my head.

 

However, I found this worked great for obviously silly and unlikely anxious thoughts but not so well for ones that were less silly e.g my husband might have died in a freak accident - not likely, versus now I've had depression and can get anxious easily I'm going to struggle to find a job when I finish my postgraduate studies - quite possible given current ecomomic environment and some peoples predjudices.

 

Just attempting to challenge the second type of thought can leave me locked into a prolonged period of rumination and this doesn't help me at all.

 

Instead I'm using some techniques from ACT - Acceptance Commitment Therapy where there are links to CBT and also mindfulness. Here there is more emphasis on noticing your thoughts come and go and noting them, you can then decide what positive action youu can take right now that might help you.

 

So for example I might start to panic about my husband being late home from work and him being hurt somewhere, I note this as my typical late home work thoughts - I do this one a lot, I quickly run through some more likely explanations e.g. perhaps his train is late. Then I considered some actions I can do to help right now e.g take a few calming breaths, if I haven't heard from him in 30mins text to see where he is. Finally I try to be compassionate to myself for being scared, this last one I'm still very much learning, I have to watch I don't tell myself off instead.

 

A useful book on ACT and anxiety I've found is the wonderfully titled:

 

Things Might Go Terribly , Horribly

Wrong : A Guide to Life Liberated

from Anxiety( Deckle Edge )

(Paperback )

Kelly Wilson, Troy DuFrene

 

There is also book called The Happiness Trap by Russ Harris about both anxiety and depression.

 

All best,

 

Bright.

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Nadia   
Nadia

Thanks so much for your responses... Brighteningup, I have the same problem with anxiety from thoughts that don't really have much cognitive distortion, or where there is an unknown (for example, doubts about my relationship and fear about hitting menopause before I have a baby). And then there is the issue of feelings out of the blue that don't seem to be tied to thoughts (perhaps neuroemotion, or anxiety that wakes me up and seems more physical than anything else). Or sometimes I get an anxious reaction to something and, at least consciously, I don't seem to be thinking anything. And then if I try to think something, it seems like I'm just randomly assigning a possible thought to a feeling.

 

The Acceptance Commitment Therapy sounds similar to a kind of therapy I did years ago, Dialectical Behavioral Training, which is like CBT mixed with a zen approach. It's designed specifically for Borderline Personality Disorder, but I bet it has a broader application. I wasn't always thrilled with it, though...

 

I'm going to try both what Patience suggests and the ACT... hopefully something will work. Lately my anxiety has really gone up and my sleeping has really gotten bad, and I'm wondering if I'm pushing out anxious thoughts so much during the day that they are getting their revenge at night. I hope using some of these techniques will help!

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alexjuice   
alexjuice

....

The Acceptance Commitment Therapy sounds similar to a kind of therapy I did years ago, Dialectical Behavioral Training, which is like CBT mixed with a zen approach. It's designed specifically for Borderline Personality Disorder, but I bet it has a broader application. I wasn't always thrilled with it, though...

 

I got a lot of DBT exposure and found it totally without use for my anxiety. My anxiety is mainly social, almost everything I get anxiety about centers around something causing embarrassment, even when it doesn't seem that is does, I can trace it back to fear of humiliation. Common fear-themes in the past were that I wouldn't measure up or would be singled out or would be judged. The notable exception is my health, but health concern has a very strong social component for me too. I rarely worried about having a heart attack or being shot by a robber, for example. However, I would worry about diseases/conditions with social stigma, say diabetes II or Hepatitis or sexually transmitted diseases.

 

I think that the DBT helped some of the people with whom I studied it. But they were nearly entirely classic borderline cases. I am not borderline. Actually, I have always been really level emotionally. In my family of upbringing, emotional displays were discouraged, so that played a role I'm sure. In any event, it is unusual for me to feel a strong emotion other than anxiety/fear (except in reaction to Drugs). I do have emotions, don't get me wrong, but I'm way more analytical than emotional. On Myers-Briggs I was 90% T, only 10% F or something like.

 

I've found CBT very helpful and think it's uses can be expanded. I think they're onto something and in light of what I've read of plasticity, I see tremendous potential for me in certain CBT techniques. I've had good success thus far and want to test-tube some ideas on how to go further. But... we'll see if that ever gets off the ground. I'm pretty overwhelmed just surviving.

 

As to cognitive distortion, I didn't realize how much of my anxiety was caused by triggers or automatic negative thinking on the subconscious level. I wouldn't usually actually think anything I could consciously catch and label erroneous. I hardly ever consciously think that stuff: "I'm a loser." or "I'm fat and too old." or "I'm going to die alone." or whatever the common thinking errors tend to be. I don't think them consciously, but I act as if I am. Somewhere in some part of my brain I'm responding as if I am thinking these things so I get the anxiety response I get. At least, I guess something like this is at play. CBT works for a lot of that stuff for me because I actually USED to consciously think negative things about myself so the pathways were established and can be triggered without conscious thought.

 

Finally, it's my experience that CBT (or approaches like it) won't often be successful with intense anxiety caused by withdrawal. CBT wasn't able to counter the chemical exhcanges going on in my brain during the worst of my w/d anxiety. I imagine it's like injecting a typical person with 2000mg of caffeine and then having them meditate. No degree of meditation will likely settle their heart rate in the face of that much stimulant.

 

Alex.i

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alexjuice   
alexjuice

I want to add that I think that social anxiety is really it's own animal. I know when I read some self-help stuff in the past (Burns) or tried 'exposure', I didn't have success.

 

The reason is that when I was afraid of looking like an idiot at the party, I would get so worked up that my anxiety would overwhelm me and I would end up looking like an idiot at the party. I would be horrified and embarrassed by my social performance because I was shaky, nervous and making people uncomfortable. My feelings were not due to a distortion or thinking error. My anxiety (fear of embarrassing myself) caused me to embarrass myself.

 

So I used an approach specifically designed for social anxiety. If you have a different anxiety disorder, or anxiety from AD withdrawal, a social anxiety approach may not be right for you.

 

Anxiety disorders, according to the Academic Anxiety Celebrity in my city, respond very well to non-pharmaceutical treatment. It's too bad shrinks make much better bank by writing pills. :-(

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Altostrata   
Altostrata

Yep, psychotherapeutic techniques won't cure withdrawal syndrome, but they may make it easier to cope with symptoms while your nervous system is repairing itself.

 

If you'd like to sample CBT techniques, here's a free online course Free online Cognitive Behavior Therapy lessons

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Nadia   
Nadia

Alex, Alto, thanks! I have lots to say, but can't get to it now... soon!

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Altostrata   
Altostrata

....

So I used an approach specifically designed for social anxiety. If you have a different anxiety disorder, or anxiety from AD withdrawal, a social anxiety approach may not be right for you....

 

Alex, more, please!

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Nadia   
Nadia

I got a lot of DBT exposure and found it totally without use for my anxiety. My anxiety is mainly social, almost everything I get anxiety about centers around something causing embarrassment, even when it doesn't seem that is does, I can trace it back to fear of humiliation. Common fear-themes in the past were that I wouldn't measure up or would be singled out or would be judged.

 

That makes sense... I think DBT helps more for anger, and is really targeted at "all or nothing" type thinking that is supposed to be at the bottom of Borderline Personality Disorder. I was diagnosed with that, but it didn't really seem to fit so that could be why I didn't find DBT generally useful (though certain elements of it definitely DID help me).

 

As to cognitive distortion, I didn't realize how much of my anxiety was caused by triggers or automatic negative thinking on the subconscious level. I wouldn't usually actually think anything I could consciously catch and label erroneous. I hardly ever consciously think that stuff: "I'm a loser." or "I'm fat and too old." or "I'm going to die alone." or whatever the common thinking errors tend to be. I don't think them consciously, but I act as if I am. Somewhere in some part of my brain I'm responding as if I am thinking these things so I get the anxiety response I get. At least, I guess something like this is at play. CBT works for a lot of that stuff for me because I actually USED to consciously think negative things about myself so the pathways were established and can be triggered without conscious thought.

 

This makes SO much sense... So maybe I just have to guess at what those thoughts are, even if I'm not consciously thinking them. I tend to constantly shoot down "biased" or negative thoughts, but I think there's something deeper I'm not getting at... like you say, a deeper attitude or subconscious belief.

 

Finally, it's my experience that CBT (or approaches like it) won't often be successful with intense anxiety caused by withdrawal. CBT wasn't able to counter the chemical exhcanges going on in my brain during the worst of my w/d anxiety. I imagine it's like injecting a typical person with 2000mg of caffeine and then having them meditate. No degree of meditation will likely settle their heart rate in the face of that much stimulant.

 

That, as well, makes a ton of sense. I feel this way particularly when I get intense rushes of adrenaline or cortisol or whatever it is that hits me in the middle of the night. But my thinking was that I have noticed that since my whole system is already in high alert, stuff that normally would be anxiety-provoking will detonate a stress response that worsens everything. I'm thinking that if I can target my usual anxiety-provoking thoughts or feelings, I could help my system wind down. Otherwise it's a vicious circle... they both feed off of each other.

 

One thing I find interesting is what anxiety latches onto... I can be OK one minute, maybe feeling amped or whatever, and then I get these fire-like rushes of anxiety suddenly... usually in response to a noise (particularly the phone ringing), or contact with a certain person, or a work thing... It seems like the anxiety likes to latch itself onto certain things and not others, though... of course, if I'm really out of control anxious, then it's everything, but normally it's stuff that has traditionally made me nervous. These things invariably have to do with contact with other people: having to negotiate a price at the market, making a phone call, etc. Even something like driving... the driving itself doesn't make me nervous, it's the negotiating with other drivers on the road... what they will think if I mess up. Generally I get anxious about messing up in front of others or having confrontations. Over the years I've tried to take the bull by the horns and make myself do stuff and that helps, but sometimes I find myself going to the most ridiculous extents not to, for example, make a phone call. The internet and email are my allies in this, but also my enemies, as I can go long periods without challenging myself.

 

I think I have to explore CBT techniques more to figure all this out...

 

Thanks for the input.

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Altostrata   
Altostrata

Just wanted to point out, again --

 

Psychotherapeutic techniques may not cure your withdrawal symptoms, but will help you cope with them. If you develop these techniques as habits, should you suffer from anxiety or depression again after you recover, you can use them to manage your symptoms.

 

These techniques may even help you remove the obstacles you've always created for yourself in your interpersonal relationships -- feelings of unworthiness or resentment, for example.

 

You don't need to be afraid to live without medications!

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alexjuice   
alexjuice

 

....

So I used an approach specifically designed for social anxiety. If you have a different anxiety disorder, or anxiety from AD withdrawal, a social anxiety approach may not be right for you....

 

Alex, more, please!

 

I learned from drug counselors the things that they themselves did to achieve sobriety, themselves. I learned from psychiatrists/psychologists the things that they learned in textbooks and studies about how I can overcome my social anxiety.

 

After all the crap, I decided I liked the LCDC approach better than the PhD psychologist's approach. Today I see a therapist who has overcome many of the issues that I deal and dealt with. She tells me what worked for her and guides me through a process she has already been through. She's very practical and basically sees me pro bono.

 

We use materials from Thomas Richards, a psychologist who (again in the LCDC mold) personally struggled with social anxiety, could find no effective treatment and, ultimately, created his own CBT-based program for the treatment of this form of anxiety. You can read a short bio HERE.

 

Richards isn't going to win a Nobel, but neither will any of the LCDCs with 20 years of sobriety...

 

I've found success with his program and think many of the techniques can be used on larger psych issues like confidence, self-esteem, acceptance, etc. I've found results are much better with consistent repetition. I struggle with this because w/d symptoms influence my mood and motivation. Still, I've made a lot more progress in a few months working with Richards' material (a person who actually knows what I'm going through) than I did in years of therapy (where my Freudian therapist was frustrated by my inability to grasp that my anxious difficulty in giving my food order to a waiter stemmed from my subconscious sexual and/or aggressive impulses).

 

Of course, I wish I'd had the chance to try effective talk therapy before getting on the pharma-train. Good psychotherapy works in many cases with, essentially, no downside. Meds... we've all had the pleasure so nothing needs saying.

 

Alex

 

ps - The downside of the Richards' series is that it is not free. And, like I said before, I actually have social anxiety -- it's why I ended up in this position -- so I want an approach specific to that variant of anxiety.

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alexjuice   
alexjuice

 

As to cognitive distortion, I didn't realize how much of my anxiety was caused by triggers or automatic negative thinking on the subconscious level. ....

 

This makes SO much sense... So maybe I just have to guess at what those thoughts are, even if I'm not consciously thinking them. I tend to constantly shoot down "biased" or negative thoughts, but I think there's something deeper I'm not getting at... like you say, a deeper attitude or subconscious belief.

 

I've found that my anxiety isn't contingent on my current thinking. For instance, everybody understands associations. Here's an example of anxiety I get that is conditioned through association. When I am driving to the site of my group therapy, a site where I have experienced intense anxiety in the past but don't currently, my anxiety symptom increase as I pass landmarks on the road as I get closer to the group. By the time I arrive on the street of the site, I am in a fairly anxious state though I am not thinking anything fearful. In fact, I already know the people in the group and know they are supportive of me. But the sequential process of driving past those markers provokes a response.

 

This is very common in social anxiety I think, this building-up process. My anxiety gets progressively worse at each landmark; it means the fear-event is getting closer. People with strong social anxiety tend to really hate these sequential situations where the pressure builds in a predictable way. For example, people with social anxiety almost universally hate going around a room introducing themselves or sharing something.

 

I also think that this why rollercoasters go 'click-click-click' as the car is pulled up the first incline. Fears get spiked when their is a countdown or a sequence to the feared event. In the case of the rollercoaster, each click means you are closer to the drop, so each upticks brings more fear. The greater the fear, the greater the satisfaction when the ride is over and the danger has passed. Though maybe there is some engineering reason necessitating the clicking... it's only my hypothesis that it's done to heighten the psycho-experience.

 

Okay... Back to what I was saying...

 

My anxiety is not rational and not always based on what I am thinking. The good news is that the many of the techniques I use, and these are not complicated, work when I am consciously having fearful thoughts and when I am experiencing fearful feelings without a simultaneous negative thought.

 

Finally, it's my experience that CBT (or approaches like it) won't often be successful with intense anxiety caused by withdrawal.

 

That, as well, makes a ton of sense. I feel this way particularly when I get intense rushes of adrenaline or cortisol or whatever it is that hits me in the middle of the night. But my thinking was that I have noticed that since my whole system is already in high alert, stuff that normally would be anxiety-provoking will detonate a stress response that worsens everything. I'm thinking that if I can target my usual anxiety-provoking thoughts or feelings, I could help my system wind down. Otherwise it's a vicious circle... they both feed off of each other.

 

Yes, this is true in my experience. I just meant that I didn't find CBT able to relieve my anxiety entirely in the worst of my early-w/d terror. There are still things I think we can do that will make the experience less terrible as well as things we can do that can exacerbate the horror. So I totally agree.

 

One thing I find interesting is what anxiety latches onto... I can be OK one minute, maybe feeling amped or whatever, and then I get these fire-like rushes of anxiety suddenly... usually in response to a noise (particularly the phone ringing), or contact with a certain person, or a work thing... It seems like the anxiety likes to latch itself onto certain things and not others, though... of course, if I'm really out of control anxious, then it's everything, but normally it's stuff that has traditionally made me nervous. These things invariably have to do with contact with other people: having to negotiate a price at the market, making a phone call, etc. Even something like driving... the driving itself doesn't make me nervous, it's the negotiating with other drivers on the road... what they will think if I mess up. Generally I get anxious about messing up in front of others or having confrontations. Over the years I've tried to take the bull by the horns and make myself do stuff and that helps, but sometimes I find myself going to the most ridiculous extents not to, for example, make a phone call. The internet and email are my allies in this, but also my enemies, as I can go long periods without challenging myself.

 

I've had problems with many of these things. Buying a car is an unpleasant experience for me. I hate it.

 

Phone calls, recording outgoing messages, returning items to stores, interpersonal conflict, feeling shame or embarrassment about body parts, interacting with sales people, eating in public, going to the restroom in public, asking for things like raises, public speaking, interacting with people in 'authority' or 'important people', running into people in public places ... along with a few score more, these are very common fears in people with social anxiety, though nobody has the exact same triggers.

 

I hadn't heard of the driving until recently, but that is one of the main examples on the tape series that I have. Driving can be triggering for all sorts of reasons.

 

Alex

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Nadia   
Nadia

I've found that my anxiety isn't contingent on my current thinking. For instance, everybody understands associations. Here's an example of anxiety I get that is conditioned through association. When I am driving to the site of my group therapy, a site where I have experienced intense anxiety in the past but don't currently, my anxiety symptom increase as I pass landmarks on the road as I get closer to the group. By the time I arrive on the street of the site, I am in a fairly anxious state though I am not thinking anything fearful. In fact, I already know the people in the group and know they are supportive of me. But the sequential process of driving past those markers provokes a response.

 

Yes! Exactly! For me most of the time my anxious response is out of the blue, before I can even form a thought, and yes, from association. Sometimes it leaks into my thinking and sometimes it doesn't, once it has been activated. But once it's been activated, it's really hard to turn off. I've spent all afternoon ignoring waves of panic that started with the phone ringing (the call wasn't even for me), for example... not letting them be attached to thoughts (or as little as possible) so as not to feed them. But there they are. I suppose it might help to think of underlying reasons for the association... often I get calls from work, work can be stressful, etc., but I'm not sure. (Mostly I end up changing my ring tone every couple of days to minimize damage, ha ha.) I'm going to look into the approach you mention.

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Nadia   
Nadia

Psychotherapeutic techniques may not cure your withdrawal symptoms, but will help you cope with them. If you develop these techniques as habits, should you suffer from anxiety or depression again after you recover, you can use them to manage your symptoms.

 

These techniques may even help you remove the obstacles you've always created for yourself in your interpersonal relationships -- feelings of unworthiness or resentment, for example.

 

You don't need to be afraid to live without medications!

 

Right now I'm being motivated into action from sheer suffering, but the truth is I should have been working harder on these things from a long time ago. Being on ADs at first was great because I "dared" to do so many things I hadn't before (disinhibition), but I realize now it also made me complacent in my avoidance later. I think about the kind of jobs I like or don't like, and what I've avoided... I'll probably stay in that trend, but maybe if I practice some of these techniques I could remove some limits. I'm not saying I'm going to work for a call center or anything, but maybe I could take and make work phone calls without so much dread!

 

I had never experienced anxiety in the way I have now... sheer, paralyzing terror, often completely unspecific, latching on to the mere feeling of existence and coupled with really random and scary sensations (I WISH it were something concrete like being afraid to cross the street, sometimes) BUT I realize now that I've struggled with some form of anxiety since I was a child (though not to the point of not being able to function, just making me unhappy), and that investing time in CBT could really help me in the long term.

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Altostrata   
Altostrata

alex, what do you do when you recognize you're in an anxiety-producing situation?

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alexjuice   
alexjuice

alex, what do you do when you recognize you're in an anxiety-producing situation?

 

First, I should probably make clear that I haven't cured my anxiety problems and that my anxiety originates from a social anxiety disorder. That said, there are several possible actions I could take depending on the situation.

 

I've learned to view anxiety differently. I've realized that anxiety, feeling fear absent the presence of a legitimate fear-producing stimulus, comes from within me. My thoughts and feelings and internal mental processes create this unpleasant thing I experiece. It's not fear b/c fear comes from an actual threat. Like being locked in a room with a rampaging gorilla.

 

Because it comes from within me, I can have at least some control over it -- vs the gorilla, by contrast, who I have no control over. With practice (repetition, repetition) I can at least dampen anxiety by asserting my executive self in my own head.

 

There are two parts: First, coginitively, I dismiss the silly anxiety and choose not to listen to it. It's not true!

 

Second, behaviorally, I gradually involve myself in situations likely to produce small successes in areas in which I feel anxiety. Each small success allows me more easily dismiss my anxious feelings. As I move up my 'hierarchy' I try to attain slightly larger successes... and so on, with the C and the B reinforcing each other... until eventually I can do formerly-impossible things with manageable anxiety, or even no anxiety.

 

There is a handout by Dr Richards, the ANTs handout, that I have more/less memorized and it's a good example of the way I'm learning to attack my Automatic Negative Thoughts and Feelings (ANTs). Feelings and thoughts are the same -- they are not equal to rampaging gorillas, and I don't have to believe them no matter how real they feel/seem.

 

Ya know, I don't know if this is a helpful explanation. It's tough to explain the anxiety CBT-program i'm using succinctly.

 

Alex

 

ps - I just googled ANTs handount, cuz that's what we call it, and that site came up. I don't know what other material is on that site. It's not 'official'.

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Nadia   
Nadia

Interesting discussion on Acceptance and Commitment Therapy for social anxiety from the Social Anxiety Support website.

 

I read a sample from the book The Happiness Trap that Bright recommended, and I think I'm going to read it and try it out. I like the idea of mindfulness and acceptance... I think it might work better for me than trying to replace my "negative" or "wrong" thinking or feeling (which in itself might tempt me to engage it too much).

 

It seems like there are overlaps with other types of CBT, and that maybe a mixed approach could work, depending on what exactly you are targeting.

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Nadia   
Nadia

Hmm... this Time Magazine article reminds me a bit of something in the Dr. Richard's audio therapy outline:

 

How to turn the tables on the ANTs, part three

Why it is necessary to first go "neutral" with our anxious thoughts instead of going positive. What your brain will accept...and what it won't.

 

The article talks about studies that show sometimes positive thinking can backfire, and how Acceptance and Commitment Therapy can be an alternative. (The link is another Time Mag article on ACT that compares it to other CBT, it's an interesting read.) A line from the article:

 

Hayes and other third wavers say trying to correct negative thoughts can, paradoxically, intensify them.

 

It seems like Richards is aware of this and uses an approach to neutralize?

 

I'm willing to be there are good things in the replacing negative thoughts approach AND the acceptance approach.

 

What interests me about ACT though is precisely where I seem to be hitting a wall with CBT... when I can't really identify a thought or a feeling that needs fixing.

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brighteningup   
brighteningup

Thanks for the link to the Time article Nadia. I hadn't seen that before and it looks like a really good explanation.

 

ACT does have some sceptics and also some people who seem to be almost cultishly enamoured of it, which nearly put me off...but as the article also says it does seem to have some scientific basis too.

 

I think it has some useful tools though.

 

Russ Harris has a web site with some free resources here:-

 

http://www.actmindfully.com.au/free_resources

 

I too have the experience of just getting anxious feelings 'out of the blue' without any clear thoughts behind them. For a while based on the classic CBT approach of finding the underlying thoughts I tried to find some - I think I may have found one which may have been helpful to uncover, but other times I couldn't really uncover anything and got stuck in many hours of rumination instead.

 

It may be as Alex says that the underlying thoughts are just buried.

 

I guess I kind of take a sort of toolbox approach to a therapeutic approach, some things seem to help more than others for me. So I'm using bits of CBT that I find helpful, bits of ACT and meditation and mindfulness too (though I found meditation much more difficult to so while I was on a higher dose of AD, its getting easier now I'm dropping the dosage).

 

I think that it's possible that none of the above will be helpful for some - I guess CBT and to a certain extent ACT may work really well if you like to try and do stuff on your own, in the UK CBT based therapy is often done as a series of 6 to 10 sessions with homework then it's stopped (this can be whether you feel ready for this or not...)

 

I never done pure ACT therapy, although a previous counsellor and the current clinical psychologist I'm seeing (whos really good) has drawn on some ACT techniques in their work with me. Interestingly when I first saw my current psychologist she said something along the lines of she didn't think I needed CBT from her as I had a pretty good insight into what the roots of my anxiety and depression were, but instead needed help to learn to accept (be able to tolerate) my more difficult emotions - and for this she's been drawing on some ACT related stuff and just the general good theraputic relationship too.

 

It makes me wonder - do (should) good therapists use a tool box approach too - offering a range of approaches tailored to who you are.

 

They say one of the best predictors of getting better from therapy, is not the type of therapy but having a good relationship with your therapist...

 

So I can really to what you say Alex - how many things haven't worked for you, and a specific approach is best for your social anxiety.

 

I think I've started rambling I should stop here...

 

Bright

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alexjuice   
alexjuice

hey bright and nadia,

 

I don't know anything about ACT. The reasons for not giving your anxiety any oxygen make sense to me if you think there are patterns to your anxiety. The more I've read people like Norman Doidge, who talks about neuroplasticity and OCD among other things, the more I believe that there are brain responses that are triggered around some anxiety producing thing. The more you fight with these parts of your CNS, the more they fire together and all that.

 

Expending mental energy proving my thinking or feeling 'wrong' is not the best use of my resources. For instance, sometimes a fear isn't wrong. But that doesn't matter. It only matters that the anxiety is affecting my life and I want it to go away. Like, say I have terrible anxiety about the earth being hit by an asteroid. Going round and round about how likely or not this is only reinforces the anxiety (for me). Truth is the earth could be hit by asteriod at basically anytime. But i don't want to spend my life crippled with anxiety about this or any other black swan scenarios that will someday cause a catastrophe.

 

I have so far had the best success by saying 'i'm not going to worry about such ridiculous fears.' And then moving on and doing something positive...

 

Alex

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Nadia   
Nadia

It makes me wonder - do (should) good therapists use a tool box approach too - offering a range of approaches tailored to who you are.

 

I think that is what would work best! I am loathe to follow any one technique blindly. I can think of situations where it would be possible and productive to replace your negative thinking, and others where you just need to accept. I'm a really sensitive person, and have had a really low tolerance to all the uncomfortable and painful feelings I can have in a day. This is the reason I started taking antidepressants to begin with. I think I DO feel things more intensely and often more negatively than many people, but I also have less tolerance for discomfort. It can be stupid things, too... like when I was a little girl, I could not tolerate having one sock pulled up higher than the other, for example. I got better as I grew older, but I still longed for ways to just feel comfortable and good.

 

I think for a lot of stuff, whether there is a cognitive distortion or not is a moot point... sometimes attempts to root out the "bad thinking or feeling" (if it's even that) can backfire. And in that case, acceptance is key. And it's a subtle point, because acceptance doesn't mean just ignoring it or putting up with stuff that you shouldn't put up with. I like the acceptance bit because it jives with my beliefs (I tend toward a taoist view of things) and, if I think of things that have helped on occasion, it makes sense.

 

For example, I have over the years had problems with sex because of some bad experiences in my teens. The problem destroyed many of my relationships, because I'd stop wanting to have sex, and the other person wanting to have sex with me seemed like an assault. It didn't matter what I thought consciously, or if I told myself over and over that the other person did not want to harm me and that it was a loving thing. If anything, this just made me feel more rejection. It also didn't help to talk about the problem or try to work it through. Finally how I was able to get over the problem (not that it is not still there, but things have improved enormously) was to just accept the negative feelings, not judge them or engage them, and let them pass on their own, however long that took. Not giving them any mental space at all except to notice them and give them time to hang out, eventually they showed up less and less... and now are practically gone.

 

In terms of a lot of what we go through in withdrawal, I think acceptance can be really helpful as well... because there are some things you are just not going to be able to change. Especially insomnia and panic that just comes from what Alto calls neuroemotion or from high cortisol or whatever... Sometimes you just have to accept and sit with the fact that you're in for some discomfort and pain. The more you try to fight it, the greater hold it will have over you.

 

Then there is other stuff where I see traditional CBT being helpful. I do sometimes get these thoughts like "I'll never be happy" or "I'm terrible at X", and they are just pessimistic exaggerations and need to be challenged and replaced.

 

So yeah, a mixed toolbox approach makes a ton of sense to me!

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Nadia   
Nadia

The more I've read people like Norman Doidge, who talks about neuroplasticity and OCD among other things, the more I believe that there are brain responses that are triggered around some anxiety producing thing.

 

I really want to read more from Norman Doidge!

 

Expending mental energy proving my thinking or feeling 'wrong' is not the best use of my resources. For instance, sometimes a fear isn't wrong. But that doesn't matter. It only matters that the anxiety is affecting my life and I want it to go away. Like, say I have terrible anxiety about the earth being hit by an asteroid. Going round and round about how likely or not this is only reinforces the anxiety (for me). Truth is the earth could be hit by asteriod at basically anytime. But i don't want to spend my life crippled with anxiety about this or any other black swan scenarios that will someday cause a catastrophe.

 

Exactly! What I try to tell myself in those situations is "even if it's going to happen, there is no use worrying about it until it DOES happen". It's like saying, "so what?" Yeah, there is a possibility of it happening, however slim, but it's a waste of time and energy to consider.

 

I guess with CBT like with anything else, the devil is in the details.

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Nadia   
Nadia

BTW, Bright... thanks for that link of free resources! Very useful. It's interesting to read the list of "Control of Thoughts and Feelings Questionnaire" in the Worksheets download.

 

It asks you how you feel about pairs of statements. Invariably, I THINK the B option, but FEEL the A option (at least deep down and if I don't watch myself). It's funny... if you took this like CBT, it would be a GREAT pair for correction. In each case replace your A feeling with a B thought, until it sticks!

 

Ex. Replace "it's not OK to feel anxious and I try hard to avoid it" with "I don't like anxiety, but it's OK to feel it."

 

As much as those psychologists get into bitter arguments over their techniques, in the end they may be closer than they think.

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Phil   
Phil

I just wanted to add to this discussion, that I have tried ACT in the past and found it very helpful.

CBT, not so much , because for me it made me "think more", which led me to worrying more. I know it's helped many people though.

 

Another therapy I have found useful is metacognitive therapy, which uses mindfulness techniques and "attention training" exercises. From what I have read it is useful for PTSD, ADHD, depression, anxiety, GAD, social anxiety, borderline personality and OCD.

Rather than focusing on thoughts, it focuses on the processes that guide and control your thoughts.

 

Here's the website for it: http://www.mct-institute.com/metacog.html

 

Here's an explanation of MCT from the site:

 

One of the features of psychological disorders such as anxiety or depression is that thinking becomes difficult to control and biased in particular ways that lead to a worsening and maintenance of emotional suffering. Many patients report that they feel that they have lost control over their thoughts and behaviours. Another important feature is that the persons thinking and attention becomes fixed in patterns of brooding and dwelling on the self and threatening information.

 

Metacognitive therapy recognises this change in thinking patterns and believes it is very important. It gives it a name: the Cognitive-Attentional Syndrome (CAS). This pattern consists of worry, rumination, fixation of attention on threat, and coping behaviours that the person believes are helpful but many of which backfire and keep emotional problems going. The CAS is controlled by metacognitions and it is necessary to remove the CAS by helping patients develop new ways of controlling their attention, new ways of relating to negative thoughts and beliefs, and by modifying metacognitive beliefs that give rise to unhelpful thinking patterns.

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Nadia   
Nadia

Thanks, Phil... that sounds interesting. I can definitely relate the the brooding thing for my depression. The idea of metacognition is interesting to me... it might help address what I feel is often my problem... thoughts about thoughts, or thoughts going on in the background that I am not aware of. Or which I am aware of but don't feel control over.

 

It happens to me a lot that consciously I think one thing, but like Alex said, I act and feel as if I feel a different way...

 

I'll look into this.

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CymbaltaDrone   
CymbaltaDrone

See links to these below from my introduction posting:

 

Mind Over Mood Workbook

 

The Mindfulness and acceptance Workbook for Anxiety

 

CBT psychotherapy with Dr. Korol

 

Although I've had extensive CBT and much success with it, I am currently trying to find a dialectical behavioural therapy (DBT) specialist locally (or via skype). I am attracted by the unorthodox "therapist as ally" approach in this type of therapy even though it is traditionally a treatment for borderline personality disorder.

 

Some Sources of Help, Support and Information That Have Helped Me

 

Edited by CymbaltaDrone

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Nadia   
Nadia

Although I've had extensive CBT and much success with it, I am currently trying to find a dialectical behavioural therapy (DBT) specialist locally (or via skype). I am attracted by the unorthodox "therapist as ally" approach in this type of therapy even though it is traditionally a treatment for borderline personality disorder.

 

I definitely found DBT useful for a lot of issues (I was in both individual and group DBT therapy for a couple of years). The mindfulness part, and finding your wise mind and such really helped, as did distress tolerance and tips on dealing with other people. I think I had trouble with some of the details, or how it was implemented in my particular case... maybe it was because it was really focused on preventing self-harm and I wanted to take it further. Oh... and now I remember something else... my therapist NEVER wanted me to talk about anything in the past (even beyond a week), as he said it was useless, but my first therapist had encouraged me to find patterns that went back to my childhood, and I had found that very helpful... so there was a point where I felt like I dead-ended with him. I wanted a bit more of the toolbox approach Bright was talking about...

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brighteningup   
brighteningup

A I think this has become a bit of CBT and other helpful techiniques like ACT and DBT topic, I found this useful free ACT on the web and wanted to share it, so thought woudl post it here.

 

It takes you through the ACT (Acceptance COmmitment Therapy / Acceptance Commitment Trainig as it's called here) method of problem solving / thinking things through as a series of 'converations' (Mp3s you can listen to online).

 

It's produced by RMIT University Australia and is aimed particularly at University students so may not be helpful for everyone but I thought it might be of interest to some of you.

 

http://emedia.rmit.edu.au/communication/

 

Best,

 

Bright

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compsports   
compsports

Hi,

 

CBT therapy for insomnia seems to be getting quite popular. This particular exert is why I won't touch it come heck or high water.

 

http://www.psychologytoday.com/blog/the-land-nod/201205/will-new-bed-cure-my-insomnia-0

 

""Most people who sleep well tend not to focus on their environment around them. For example, they sleep well despite repetitive outside noise like airplanes, trains and city streets. Sudden noises (such as thunder) can wake people, but consistent nightly noise isn’t much of an issue as the sleeper eventually gets used to it. Those who have chronic insomnia tend to become more aware of anything that might be a “threat” to getting good sleep: the ticking clock, light from the cable box, a snoring bed partner. Someone with chronic insomnia then tends to focus and sometimes obsess on these sleep threats, causing one to stay up even later due to the anxiety that's created""

 

WTF? I am getting so tired of people being blamed for their problems essentially. I am sure there are "normal" sleepers who would have a very hard time with noise just like there are insomniacs who can't sleep even when it is quiet.

 

I also find this ironic because these are the same folks who create these sleep hygiene rules that act like you have committed serious violations if you don't follow them and encourage this obsession that the author claims that people with insomnia have.

 

By the way, this is getting quite popular in supposedly helping people adjust to cpap treatment. Of course, the medical professionals don't want to look into the reasons why it is failing and instead simply want to pawn people off onto CBT.

 

ARRGH!

 

CS

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alexjuice   
alexjuice

I've tried CBT for social anxiety and largely benefitted. However sometimes it doesn't help or even hurts. My therapist has no clue about disturbed nervous system function. Because of this she argues that certain elements which aren't working, which I say is due to my rewired wiring.... Well, she just sorta blames me, like I'm not doing it well enough, hard enough or properly.

 

I have to tune her out a lot because of her ignorance but after a while it starts to eliminate the benefits. I imagine with insomnia this would be even more unbearable.

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Barbarannamated   
Barbarannamated

CS,

 

THUMBS UP to your analysis.

 

Im not an expert on sleep, but know there are many different levels of sleep and where it can be disturbed. Classic insomnia/laying awake is just one sleep disturbance. As most of us know, these drugs may allow us to appear to be sleeping but not get the good level/quality of restorative sleep. How does one do CBT for that??!

 

Ick. That's one of my hot buttons, too.

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compsports   
compsports

Hi Alex,

 

""I've tried CBT for social anxiety and largely benefitted. However sometimes it doesn't help or even hurts. My therapist has no clue about disturbed nervous system function. Because of this she argues that certain elements which aren't working, which I say is due to my rewired wiring.... Well, she just sorta blames me, like I'm not doing it well enough, hard enough or properly.""

 

I am sorry that you get treated like that.

 

I don't understand this cluelessness about disturbed nervous systems. I mean, even if you don't understand it, shouldn't as a therapist at least understand that people vary regarding this? Shouldn't the therapist in the article I quoted understand that people are different regarding their noise tolerance levels?

 

""I have to tune her out a lot because of her ignorance but after a while it starts to eliminate the benefits. I imagine with insomnia this would be even more unbearable.""

 

This is exactly why I won't touch CBT therapy for insomnia with a ten foot pool. I can't imagine putting up with this BS in a sleep deprived state.. I would be in danger of getting the cops called on me:)

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compsports   
compsports

CS,

 

THUMBS UP to your analysis.

 

Im not an expert on sleep, but know there are many different levels of sleep and where it can be disturbed. Classic insomnia/laying awake is just one sleep disturbance. As most of us know, these drugs may allow us to appear to be sleeping but not get the good level/quality of restorative sleep. How does one do CBT for that??!

 

Ick. That's one of my hot buttons, too.

 

Hi Barb,

 

Thanks

 

Great question for which I have not found a good answer.

 

Regarding being noise sensitive, I am that way when I am awake but that doesn't mean I get hit with a label.

 

Also, I recently read an article where hospitals are starting to realize that the excess noise impedes recovery of hospitalized patients. No one has said, you're an insomniac, deal with it.

 

CS

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alexjuice   
alexjuice

Hi Alex,

 

""I've tried CBT for social anxiety and largely benefitted. However sometimes it doesn't help or even hurts. My therapist has no clue about disturbed nervous system function. Because of this she argues that certain elements which aren't working, which I say is due to my rewired wiring.... Well, she just sorta blames me, like I'm not doing it well enough, hard enough or properly.""

 

I am sorry that you get treated like that.

 

I don't understand this cluelessness about disturbed nervous systems. I mean, even if you don't understand it, shouldn't as a therapist at least understand that people vary regarding this? Shouldn't the therapist in the article I quoted understand that people are different regarding their noise tolerance levels?

 

""I have to tune her out a lot because of her ignorance but after a while it starts to eliminate the benefits. I imagine with insomnia this would be even more unbearable.""

 

This is exactly why I won't touch CBT therapy for insomnia with a ten foot pool. I can't imagine putting up with this BS in a sleep deprived state.. I would be in danger of getting the cops called on me:)

 

I only know my CBT therapist and she's just not very sophisticated. She was really helpful with basic drills but she isn't able to understand the complexities involved. And things change. I'm not in as good of condition as I was in 8 months ago. I met her bc she offered a free support group and she offered to work with me on nicety bc she is a good person ho felt I'd been misdiagnosed and screwed. But that's as far as she's able to understand. Since I'm off the meds, I should be fine. Her office is full of NIH brochures and NAMI stuff. She rambles about stuff she is vastly under informed about. She got an online degree from a university with probably the weakest reputation in the united states among informed adults... Unless you're a big Jerry Falwell fan...

 

Anyway, her ignorance is becoming less tolerable as my energy level and willingness to drive 45 minutes to her office disminishes.

 

Im not entirely sleep deprived but I'm pretty exhausted. I don't have the energy to get mad or explain, I just move the ball forward. Maybe I should give it up since social anxiety isn't really an issue at the moment, but it gets me out of the house...

 

Comp, I don't blame you. Having to listen to people who talk nonsense-explanations for what I'm going through is among the worst features of this thing...

 

Hang in there.

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compsports   
compsports

Hi Alex,

 

Thanks!

 

Are there other ways you can get out of the house? Dealing with someone who has NAMI brochures seems like it is a hopeless situation.

 

Of course, you know more than I do so I don't want to sound like I am being a know it all.

 

I know what you mean about moving forward. I wish I had had the energy to complain about that first sleep medicine physician I saw who demanded I see a psychiatrist but I just don't.

 

I had another thought about my objection to CBT. It seems like it is being used like meds as a first resort when perhaps the patient has an underlying issue that is causing the problem.

 

Now I do realize that CBT doesn't have dangerous med side effects but it still has the effect of being totally demoralizing by pathologizing a patient with a psychological issue for what may be a correctable medical issue.

 

""I only know my CBT therapist and she's just not very sophisticated. She was really helpful with basic drills but she isn't able to understand the complexities involved. And things change. I'm not in as good of condition as I was in 8 months ago. I met her bc she offered a free support group and she offered to work with me on nicety bc she is a good person ho felt I'd been misdiagnosed and screwed. But that's as far as she's able to understand. Since I'm off the meds, I should be fine. Her office is full of NIH brochures and NAMI stuff. She rambles about stuff she is vastly under informed about. She got an online degree from a university with probably the weakest reputation in the united states among informed adults... Unless you're a big Jerry Falwell fan...

 

Anyway, her ignorance is becoming less tolerable as my energy level and willingness to drive 45 minutes to her office disminishes.

 

Im not entirely sleep deprived but I'm pretty exhausted. I don't have the energy to get mad or explain, I just move the ball forward. Maybe I should give it up since social anxiety isn't really an issue at the moment, but it gets me out of the house...

 

Comp, I don't blame you. Having to listen to people who talk nonsense-explanations for what I'm going through is among the worst features of this thing...

 

Hang in there.""

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