The Cognitive Behavioral Therapy Support Thread

Miscellaneous and Personal Stuff I Must Share
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I checked with twickster, and she gave me the OK to start this thread.

Many of us here have had, currently have, or must actively work to avoid, depression. And many people have used or are interested in CBT.

So this thread is meant as a virtual CBT support group. I’ve noticed that it’s a lot easier for me to recognize the distortions in other people’s thinking, and I could probably use some help from understanding people to tell me, “Hon, that’s mind-reading and magnification,” and such. I also could use the accountability of other people checking in with me - it will make me more likely to do my exercises. And I imagine other people might feel the same.

Caveats:

  1. this is a peer support group meant to be used in addition to, not instead of, medical care, whether that’s medication with an M.D., therapy with a psychologist, or both.
  2. If you have any suicidal thoughts, contact your doctor, therapist, or a suicide hotline immediately.

To help us out, here is a list of cognitive distortions:

  1. All-or-nothing thinking - Thinking of things in absolute terms, like “always”, “every”, “never,” and “there is no alternative”
  2. Overgeneralization - Taking isolated cases and using them to make wide generalizations.
  3. Mental filter - Focusing almost exclusively on certain, usually negative or upsetting, aspects of an event while ignoring other positive aspects. For example, focusing on a hair out of place in an otherwise beautiful picture of yourself.
  4. Disqualifying the positive - Continually de-emphasizing or “shooting down” positive experiences or attributes.
  5. Jumping to conclusions - Drawing conclusions from little or no evidence. There are two specific subtypes:
    [ul]
    [li]Mind reading - Assuming special knowledge of the intentions or thoughts of others.[/li][li]Fortune telling - Assuming what will happen in the future, or indulging in excessive “what if” scenarios[/li][/ul]
  6. Magnification and minimization - Distorting aspects of a memory or situation through so they no longer correspond to objective reality. For instance, magnifying the capabilities of a colleague or friend while minimizing your own. This distortion includes
    [ul]
    [li]Catastrophizing - Focusing on the worst possible outcome, however unlikely, or thinking that a situation is unbearable or impossible when it is really just uncomfortable.[/li][/ul]
  7. Emotional reasoning - using feelings as evidence that negative thoughts are true, or to justify negative actions.
  8. Should statements - Patterns of thought which imply the way things “should” or “ought to be” rather than the way they are, such as thinking someone should be perfect, when no human being can possibly be.
  9. Labeling - assigning a permanent, overarching character to someone based on temporary behavior - calling someone “a jerk” when they act rudely, or calling yourself “a loser” when one thing goes wrong.
  10. Personalization/Blame - Attribution of personal responsibility (or causal role) for events over which one has no control. Can be directed towards self or others.
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So, now that the housekeeping is taken care of, I’ll go first.

I’m starting the Feeling Good Handbook, and it’s already helping just to have that list of distortions fresh in my mind. I tend to feel really overwhelmed, and therefore unmotivated, about taking care of my house. I can take care of the kids pretty well, because their needs are immediate, but when I think of that to-do list looming over me, I want to pull the covers over my head and never get up.

Lately, in fact, it has even been hard for me to psyche myself up to shower, which I recognize is not normal or healthy. And that, in addition to me being really irritable, was what inspired me to get back on track with my CBT. I do have a psychologist I see regularly, but she’s not really the “homework assignment” type, so I’m doing the workbook with her knowledge, but she’s not going to be cracking the whip on me.

So, let’s just take my to-do list. When I think about it, I think, “There is not enough time to get even a fraction done.” My husband says to just try to do one thing per day, over and above keeping the kids healthy and fed, but it seems like that is almost too much all on its own. Making dinner is like juggling. Somehow everything seems to hit the fan approaching dinner time, and I’m constantly interrupted. Plus the kids start whining about how they’re hungry, and I’m like, “I’d be done making it if YOU’D STOP INTERRUPTING ME AND STRESSING ME OUT!” Not that I yell out loud, usually. I just have all the tension building up inside me like a spring that’s about to snap!

I guess a lot of this is magnification. There’s a lot to be done, but if I have a good day I tend to accomplish a lot. And the children aren’t impossible, they’re just normal kids.

My main problem is that stress just building up. I’m not sure how to get at that with the distortions yet.

Also, why does the negative crap accumulate, when the positive stuff is fleeting?

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Wow, see I thought I felt so overwhelmed by my kids and house because I’m a big fat lazy loser. I really thought I was the only one. Which cognitive distortion is that? You’re helping point out some serious flaws in my thinking.

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Ain’t it awful?

Don’t do that. :wink:

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Magnification. From the OP:

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And mondo labelling, torie. Being overwhelmed by your kids, house, and school* is a normal human reaction, not being a “loser.” And I bet most of the time you manage to juggle things so they keep relatively on keel.

I think SO MANY mothers magnify other mothers’ abilities and accomplishments. I suspect the truth is that the vast majority of us sit in our isolation inside our houses feeling like we’re drowning, while all the moms we see are keeping it together. Then we put on makeup and a smile and go to the grocery store and appear to all the other desperate mothers like we’re keeping it together and they feel like losers in comparison. :confused:

*“She’s doing what you’re doing, PLUS school, Cinnamon, *you’re *the loser,” says my demented side

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This website is decent too, and has some supplemental info about irrational and rational beliefs.

http://www.stressgroup.com/ABCworksheet.html

Irrational beliefs.

http://www.stressgroup.com/12IrrationalBeliefs.html

Rational beliefs.

http://www.stressgroup.com/rationalbeliefs.html

I’ve got an Albert Ellis book somewhere I need to get out. I’ve been having a lot of irrational and destructive thoughts lately.

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It quite literally saved my life. I had a series of personal disasters in 2001, with after effects and new troubles carrying through to 2003. In 2002 my then wife and best friend noticed I was not nearly the same person and recommended I get some help.

My best friend had been through CBT. She and I are fairly similar in many important ways - skeptical, results-oriented, etc.; so I believed it had the potential to help and was willing to give it a shot.

I worked with a therapist over the phone once a week, did the exercises and talked about things honestly. After three months he fired me as a patient because he believed I’d made enough progress to not need the help any more. “I helped you put useful stuff in your toolbox; it’s up to you to remodel the house. Give me a call if you have a particular problem, but you should do fine on your own.”

And I have. Sure, over the last 7 years there have been times when I backslid and reverted in some ways, but as soon as I realized it I was able to start over (which sucks) and move forward again (which doesn’t).

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Cool idea for a thread. Where did you get the list in the OP? I’ve been in CBT for two years now (wow!) and it is wonderfully effective. I recognize many of the concepts in the OP, but my therapist doesn’t label things as such while she works with me to overcome them. I’m interested in learning more about CBT in general.

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I wanted to add that CBT is used very successfully for anxiety disorders as well. I’m almost five years recovered from a 13 year long anxiety disorder using CBT and a real-life support group, as well as books and workbooks (medicated for 13 years, and medication free for almost five now). I’m a co-leader of the anxiety support group now. :slight_smile:

ETA: Did we address perfectionism? That’s a negative behaviour that so many of us are frantically engaging in. The perfectionist with anxiety runs themselves ragged trying to do everything perfectly all the time for everyone. The perfectionist with depression just stays in bed (because why bother if you can’t do it just right anyway?). :slight_smile:

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First: Holy crap Cat Whisperer, I knew there was a reason I liked you. Turns out it’s cuz you’re featherlou.

Second: Thanks SO MUCH for starting this thread, UC. CBT rescued me from being a non-functional ball of misery. I’m much more high functioning than I once was, but I still battle depression and anxiety on a regular basis.

I’m having a long and complicated problem that needs dealing with, CBT-style. Maybe someone can see something I’m not seeing.

I am currently undergoing prolonged exposure for PTSD, which is a form of CBT.

What is it? Basically you relive a specific memory over and over again until your are a weeping, screaming, trembling, stuttering mess, and then you… start back at the beginning and relive it again, about 3-4 times in a row every day. Eventually, the research says, you’ll get so used to all those crazy feelings that you’ll stop being afraid of them. Your story will get boring and it’ll stop popping up at inconvenient times, like standing in line at the bank. You are expected to go through this process for one hour every single day by listening to the recordings of yourself talking from therapy. You’re also expected to do things that trigger traumatic memories and make you want to crawl out of your skin – again, at least once a day.

So what this looks like, in case it’s not obvious, is spending two hours a day being scared out of your everloving mind. This is what I signed up for, what I’m paying out the ass for. Why? Because according to the research, it’s the most effective treatment out there. The clinic I’m working with has an 80% success rate.

Now comes the problem of self-sabotage.

This therapy well and truly sucks to go through. It’s quite difficult to explain if you haven’t done it. When I first signed up, they estimated it would take 8-10 sessions, and they told me that they expected my symptoms to get worse for a little while before they got better. I was thinking this would happen for 2-3 weeks and I would start feeling better.

Well, we all underestimated how much work this would be. It has been 2 months and I’m still not finished processing the first memory. And I have, oh, a bazillion. I have seen some improvement around this one memory and feelings and emotions related to it, but I have not seen any decrease in my depression or anxiety because we have so much more shit to slog through. I woke up at 5am this morning terrified out of my mind and I couldn’t fall back asleep. The very first thought I had this morning: ‘‘I am so tired of being afraid.’’ I’m not okay.

I am a full-time graduate student with a 24 hour weekly internship requirement. I have an average of one research paper due every week. In those rare, precious moments where I have free time, the absolute LAST thing I want to do is go think about my horrible past. I’ve also been plagued by depression since I started the semester, and I can’t shake it.

So what happens is, I avoid listening to the recording, either because I just want to relax OR because I’m so freakin’ depressed I can’t get off the couch, which then delays my progress even further. I just feel like I’m caught in this endless loop of failure. I don’t know why I’m having these issues, but all I’m hearing in my head is my mother’s voice yammering on about how irresponsible and immature and inconsiderate and self-centered I am. I’m extremely pissed at myself for sinking all this money into what I basically view as my only hope of full recovery and then not doing the work required. I think I’m afraid to do it because I’m terrified it won’t work. Because if it doesn’t work, I don’t know what I’m going to do.

Some ways I am already trying to deal with this:
We’re incorporating Behavioral Activation into the in vivo (real-life) exposure. I am trying to use BA techniques to cope better with the depression. Of course, it just adds another thing to my already overwhelming list of things I have to do every day.

Today I thought it might be a good idea to start scheduling my imaginal/in-vivo sessions a week in advance. So tonight I need to sit down and work out a schedule for the entire next week, even though we’ll be on vacation.

These are my ideas so far. Please lt me know if something jumps out at you. I am feeling pretty badly.

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I’ve done CBT before. It’s no cure-all, nor is it effective for all types of depression. Still, it has its place in psychiatric treatment. If the source of your depression is a focal, localized misconception then it’s just what the doctor ordered, so to speak. For many people it won’t do a thing though.

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It’s arguably the most effective treatment there currently is for depression, with a vast number of randomized controlled trials and benchmark studies indicating its efficacy. Which isn’t to say it would work for everyone, just most people. Sorry it didn’t work out for you. :frowning:

ETA: Sorry to be a pain, but I’m not climbing off of my CBT soapbox until therapists are consistently using evidence-based treatments for psychological disorders. It is a moral obligation of therapists to use treatments that have been proven to work. I say that as someone who wasted 8 years of my life trusting that I wasn’t getting treatments therapists pulled out of their ass. They meant well, but they wasted nearly a decade of my life. The best thing we can do is educate the public about what works and what doesn’t. Since therapists who use unproven treatments obviously won’t take the responsibility, it is important that those seeking treatment are fully educated.

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I’m not sure I completely buy this either. We have lots of people in my anxiety group who don’t seem to progress, but almost universally, they aren’t actually doing the work to get better or they are sabotaging themselves in some way (and CBT is hard work, we make sure everyone in our group knows that). CBT is very much a treatment where you get out of it what you put in.

I really don’t agree that it doesn’t do a thing, either - there aren’t many people on the planet who can’t stand to have more positive thoughts and behaviours in their life, and that is basically what CBT is - instead of creating a negative experience for yourself, you try to create a more realistic, positive experience for yourself. And why not? Life is so much what you make of it - some people have a crappy life, and they are happy and satisfied. Some people have everything, and they’re miserable. The big difference is attitude. There’s absolutely no reason why anyone can’t improve their attitude, regardless of depression and anxiety.

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Um… uh oh. :frowning:

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How often are you supposed to do the CBT exercises/homework? Is it a 1x per day thing, or does it work better if you split it among the day?

Another thing that couldn’t hurt is keeping a gratitude journal.

http://psychology.ucdavis.edu/labs/emmons/

http://www.cfidsselfhelp.org/library/counting-your-blessings-how-gratitude-improves-your-health

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Yeah, no kidding! You mean this isn’t Collect Them All?!!

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Just looking at the OP - that’s a neat list, thank you. Very succinct.

A lot of people - like ME - grew up in houses with poor mental health. I need to work hard to practice GOOD mental health habits, for myself and for my children. Right now my nearly-6-yr-old son is really into globalizing and what-iffing everything and he jumps to conclusions like an Olympic champion, and frankly it’s SO irritating I really just want him to shut up.

But instead I’ll work on helping him through these obstacles. So hopefully the next generation of our family will be another few degrees healthier.

I’ve had some luck teaching them to look on the bright side, I saw evidence of that yesterday. As he was exiting the car he tipped his Happy Meal box and a bunch of fries fell onto the garage floor. He looked into the box and noted “At least I have a few left.”

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Shit. And I was feeling so proud of myself … :frowning:

:wink:

ETA: I ordered the workbook that Olives recommended in the other thread.

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**Green Bean **- I used the list from the Wikipedia entry on CBT as a framework, and edited heavily, using information from the Feeling Good books and the list at about.com’s depression page.

Cat Whisperer, I think perfectionism falls under “all or nothing” thinking. Either “I must have everything under control, no exceptions,” or “I have to do this perfectly, and I might fail at that, so I better not try.”

olivesmarch4th, let me try to point out a couple distortions in your thinking about the exposure therapy. First, it sounds like it sucks, so you have my sympathies. I don’t think anyone can argue that this is something you shouldn’t be upset by.

IME, this kind of thing is one of the hardest things to cope with. You set up an expectation and gird your loins for a certain amount of suffering . . . and then find out it’s a lot more. This is really disappointing and scary, but at the same time, subject to the “should” statements distortion. You get extra upset because, dammit, this SHOULD only take X amount of time, and it’s not conforming to specifications.

This is magnification. You may have a lot, and a lot more than you’d like to deal with, but it is a finite, real number.

You haven’t been able to shake it yet, but saying “I can’t shake it” may be verging on fortune-telling, making the situation seem worse than it is.

Catastrophizing. Most things aren’t endless, even when it feels like they will be.

Lots of blame and labeling here.

Fortune-telling and catastrophizing. It will probably work, given the research. And even if it doesn’t, you will do something, even if you don’t know what yet.

I bet you are using emotional reasoning too - because you feel like things are desperate and hopeless, they must really be so.

Also, I think you should talk to your therapist about the details of how this works. It seems to me, the first iteration is likely to be the hardest, with the beneficial effects carrying over to other discrete memories, so they are blunted before you even get to them. (I say this knowing nothing about the research, just going by how my own brain works.) Also, if something awful happened to you every day for a year, do you really have to invest two weeks 365 times? Or is there some grouping mechanism, whereby your “bazillion” memories are actually dealt with more efficiently? I suspect the latter.

Every depressed person can sympathize with the procrastination behavior. Given the suffering involved in the exercise, it is completely understandable. I really admire you for coming up with a plan to move forward, especially when you are actively depressed. (And don’t you dare minimize or disqualify the positive in that compliment!)

I hope that was coherent, and maybe even helpful.