Love is the drug but I'm allergic to love

June 18, 2009 7:45 PM

Summary: I have a crippling problem that I want to fix, but can the cure help me when I don't believe in it? Social anxiety disorder and CBT - can CBT help me if I think positive affirmation is a crock?

The problem:
I have social anxiety disorder, quite badly. I was pretty happy when it showed up in the public eye a year or two ago; when I read a description of it the first time I cried all night just from the.. relief?... of understanding for the first time that the constant pain and stress of what I just thought of as my life had a cause, and not just that I was irredemiably unsuited to existence in the world. I've been clinically depressed and occasionally non-functional for my entire life (and I do mean from my first childhood memories) because of this, and basically the only reason I *do* function is that I dearly need a safe private space away from people to feel even a little comfortable, and that means rent which means money which means a job so... I've learned how to walk out my door and interact. This means I'm always at least minimally stressed, and usually end the day in a bad mental state (blaming myself for a thousand social failures), but it's better than spending my life lying on the floor behind the bed.
Anti-depressants have helped, but only so much. I need therapy, I know, if only to keep my prescription for the anti-depressants.... I've avoided therapy for a long time because of a time when I was committed as a child (and then released into an even worse situation, but that's another story). I've come a long way just by analyzing my own behaviour and looking for positive role models for behavior; I've stopped cutting, stopped being anorexic, and haven't tried to kill myself in a decade. Though I still have daily urges to both cut and kill myself as part of the self-blaming cycle at the heart of social anxiety, I can treat them as fantasy wishes and unrealistic and nothing that would ever actually happen and they just don't. I've managed to work myself around to accepting therapy as a needed positive and not something to be avoided, but there's a catch.

The cure:
The treatment for social anxiety disorder is CBT, Cognitive Behavioral Therapy. As I understand it, in some ways CBT isn't far from the way I've improved myself in the past - recognizing bad patterns and finding a better alternative for the inherent negative response.
But another way CBT seems to be presented is being about positive thinking - I am a special flower and deserve all the good yadda yadda. But the thing is... I think that special flowerhood is bullshit, and dangerous bullshit at that. I think that telling everyone that they are special and deserve good things is untrue and leads to bloated self-esteem and unrealistic feelings of entitlement. Among the millions and billions of us in the world, many of us *are* coasting, parasites. Contributing nothing, consuming, passing on. There may be a special flower in everyone but it doesn't bloom as often as the fairy tales would have us believe.

Social anxiety disorder is about feeling negatively judged by the world, completely against logic and common sense. Thus CBT would surely be aimed at changing my view of myself to be "better" i.e. not the negative object that is currently the target of the perceived hostility of the world. But I don't particularily think that I'm a special flower, nor do I think it's necessary that I be a special flower, nor am I likely to respond well to attempts to have me think of myself as such.

So... not seeing positive affirmation as a good thing for humankind in general, and believing it to be a false and harmful lie the very notion of which I find repugnant... what can I do?
For those who have done CBT, and specifically for social anxiety disorder: how much of it is about being a special precious flower who just needs to believe their own validation? Because that just won't cut it with me. I want help, but I don't think that I will be helped by heaping my plate with what is to me meaningless self-validation.
What is CBT like for those in it?
What alternatives are there for CBT if it proves too special-flowery to penetrate my philosophy?

I'd really like to live in the world without being constantly frightened and stressed. I'd like to have a week or even a day where I don't hate myself and think of death as a relief from the burden of simply living. I'd like to think there is a way.

posted by anonymous to health & fitness (26 comments total)

CBT doesn't necessarily overlap with Stuart Smalley. I have used it for a garden-variety anxiety disorder and in my case it had more to do with breathing, mental exercises like meditation on a particular object in the room, and recognizing thought patterns that weren't helpful in the hope of heading them off at the pass. CBT in your case might have more to do with establishing some new ways of thinking that don't focus on other people judging you (or insert focus of anxiety here), not just having more confidence in their judgments.

Hope that makes sense.
posted by chesty_a_arthur at 7:51 PM on June 18

CBT in my experience did not involve any of the kinds of "special flower" positive affirmation you describe. It did have a lot to do with replacing anxious thoughts with more realistic ones: "I'll die if I drive on the freeway!" with "There are some risks involved in driving on the freeway, but accidents are really quite rare compared to miles driven. Probably I'll be OK."

It had, for me, to do with thinking realistic thoughts about myself as well: "What will people think if they see that I spilled a drop of coffee on my shirt!" "Most people probably won't notice. And even if they do, they'll realize that it's not that big a deal. Everyone has spilled something on themselves at one time or another."

It also had to do with modifying actions, and understanding how actions reinforce or undermine fears--i remember when I had to inject myself with a medication every day during my second pregnancy, my therapist reminded me not to hesitate the first time or let the nurse do it for me, because that would only reinforce the idea that this was a big dramatic deal and something to be afraid of.

I would be surprised if CBT was too special-flowery. Your description of it as being like that bore no resemblance to my own (incredibly helpful) experience of it.
posted by not that girl at 7:57 PM on June 18 [2 favorites]

I'm not a mental health professional in any capacity, but:


Are you around other people every day? I mean in a work or school situation-- somewhere where you see the same people regularly. Something that has really helped me deal with my panic attacks and anxiety on my own is to mindfully act like a normal person in public. When someone asks you how you are, respond like people normally respond. If they mention something you don't know about (or even something you do), ask them about it.

Example:
Them: Hey, what's up?
You: Not much, how about you?
Them: Nothing exciting, I've just been knitting a lot.
You: Oh, cool! I've always wanted to learn to knit. What are you making?
...and so on. Nothing deep, over pretty quickly.

I know it sounds really obvious, but making an effort in small talk can really make you feel more connected to the people around you, which can make you feel much safer and more comfortable in public.

(I'm definitely a proponent of everyone being in some type of talk therapy, if only for a short period. By no means discount that option.)
posted by oinopaponton at 8:03 PM on June 18 [1 favorite]

I think your understandings of what CBT is going to be like are actually not what CBT, in most practice, really is. In other words, you're setting up assumptions and reacting to them, rather than reacting to a reality you're encountering.

You're also doing that thing of tackling everything with your best tool- analytical thought. If you can accept that a practice is effective 90% of the time when done correctly, and that CBT is theoretically effective a lot of the time, then it's in your interest to make a good effort at doing it correctly whether or not you believe it's going to work. In other words, in this situation, your belief about what you are going to try is actually irrelevant. This sort of thinking is unhelpful, so be willing to discard it in favor of thinking that is likely to be helpful - at least for long enough to test this system on its own terms.
posted by Miko at 8:18 PM on June 18 [6 favorites]

In David Burns's book "When Panic Attacks," one of the things he stresses is that mindlessly repeating affirmations won't work unless it's something you can actually believe -- like, 85% of the way at least, if not 100%. You can find positive reframings of the situation that are hopeful in a realistic way, not just blindly cheerful. -- "Even if the worst case scenario happens, I can find a way to get through it." "That mistake I just made was really embarrassing, but everyone makes embarrassing mistakes sometimes."

Sometimes it happens to me that I get panicky when I feel I don't deserve something -- I gained weight, so I don't deserve to get new clothes. I lost the $20 I was going to spend on lunch, so I don't deserve to get lunch. In a situation like that, it doesn't work to tell myself that sure I deserve it because of my dignity and specialness as a human being (not sure if this is quite the same as what you're calling special-flowery-ness) -- but I think it's perfectly consistent with CBT to attack it from a more practical angle -- "I have to go to class whether I eat lunch or not, and if I can't concentrate because I'm hungry, I'll have wasted more than $20." "It isn't really relevant whether I'm a terrible and lazy person. What's relevant is that I'm not allowed to go to work naked." That is the kind of affirmation I can live with.
posted by Jeanne at 8:19 PM on June 18

I'd really like to live in the world without being constantly frightened and stressed.

Reading again: yeah. Just prioritize this important need over the other crap you're telling yourself. It's the main thing. If you really want to live without being constantly frightened and stress, it's probably worth the price of tentatively working with a system you haven't yet fully accepted. Happiness isn't overrated.
posted by Miko at 8:21 PM on June 18 [5 favorites]

I used to have panic attacks so long ago that no one had a name for them, so was sent to a psychiatrist because the gp and specialists I'd seen thought I was genuinely crazy. Best thing I ever did as I ended up with an intimidating doctor who turned out to be a very practical person. He gave me simple techniques for dealing with the panic attacks and the stress that was causing them. Now, I got lucky the first time out (after not being so lucky with regular doctors for 2 years beforehand), but you may need to shop for a doctor with suggestions that make sense to you. I agree, the "I'm a special flower" stuff makes me want to laugh out loud. Perhaps more behaviour mod than dream analysis is what you're looking for.
posted by x46 at 8:35 PM on June 18

about positive thinking - I am a special flower and deserve all the good yadda yadda. But the thing is... I think that special flowerhood is bullshit, and dangerous bullshit at that. I think that telling everyone that they are special and deserve good things is untrue and leads to bloated self-esteem and unrealistic feelings of entitlement. Among the millions and billions of us in the world, many of us *are* coasting, parasites. Contributing nothing, consuming, passing on. There may be a special flower in everyone but it doesn't bloom as often as the fairy tales would have us believe

CBT might help you understand that your passionate loathing for the idea of special flowerhood is based on a cognitive distortion (magnification/slippery slope/overgeneralization).

Also, you might care to muse on what it is that you believe makes you such a specially dismal little flower that you don't deserve good things.

If you habitually treat other people badly enough to justify the emotional savagery you're inflicting on yourself, start working on changing that. Because the moment you've actually made that start, there is no longer any reasonable justification for any of the negative things you believe about yourself that are currently making you miserable, and you should in theory just be able to let those go and get on with your life.

If you find that letting those beliefs and thought patterns go is hard - and I expect you will, because beating yourself up is itself a longstanding habit - then you may well find CBT (specifically, its REBT branch) quite useful.
posted by flabdablet at 8:36 PM on June 18 [7 favorites]

1) Everyone above is right -- CBT is about replacing maladaptive thoughts with *realistic* ones, not ridiculous "The world is made of bunnies and rainbows, and I am the special-est bunny of all" stuff. However, a lot of therapists will incorporate other useful stuff into their mainly-CBT practice, so I should tell you that . . .

2) Yes, the affirmation stuff will totally work, even if you don't believe in it at all. I still can't talk about any of the things I did in therapy -- including the classic write-down-affirmations-and-read-them-every-morning thing -- without rolling my eyes and making what my sister calls "defensive irony hands." It all just seems really lame to me. But dude, was it ever worth it. While I will never win an award for most functional person in the world, I've become more sure of myself, more comfortable in my own skin, and much much less paralyzed with anxiety and indecision. As my counsellor explained it, all the affirmations etc. are for your unconscious self, the part of you that is totally illogical and emotion-driven, and can therefore only be fixed with illogical, emotion-driven exercises.

In summary: totally lame, but totally helpful. I say go for it!
posted by TheLittlestRobot at 8:52 PM on June 18 [3 favorites]

CBT is not about filling your head with mindless happy talk. It's about readjusting the unrealistic narratives in your head so that they are more realistic. So instead of thinking "I ruined the party last time and now everyone hates me and I shouldn't even go to this new party, which I'm sure they don't even want me to attend," you think "I left a little early from the party last time because I was ready to go. I obviously didn't ruin anything, because they invited me back to a party again. So chances are, no one hates me." See the difference?
posted by scody at 9:00 PM on June 18 [4 favorites]

CBT is not the same thing as positive affirmation. In fact, limiting yourself to positive affirmation would hamstring CBT. CBT is about looking at a thing from all angles. It's about logic, about evidence, about rationality. It's about calling yourself on your own unnecessary punitive bullshit and rooting out irrational and unsupportable conclusions. It makes you be honest with yourself. Sometimes that means that you do have to relent in your determination to see yourself as horrible because, if you are being honest, the evidence for it just isn't there. You might even have to admit something positive if that's what the evidence says.

Once you can no longer justify your negative impressions with supporting evidence, you have to ask yourself what the real reason you think/feel that way is. Maybe you'll find that you're harboring a delusional impression of yourself because, functionally, it gets you off the hook for something else, protects you from something you're afraid to face. For example if you don't leave the house, then you won't encounter any challenges. If you don't encounter any challenges, there is no risk of failure. If you can't fail you won't have to feel _________ (whatever) and won't have to further acknowledge some negative assessment of yourself that you secretly harbor but kind of squint to ignore. That gives you a safe illusory space in which to hide from your other delusions. That's just an example and may or may not apply to you; a therapist can help you discern and navigate those pathways.

You don't have to buy into some picture of yourself as a special flower to recognize, for example, that the idea of you being the target of the perceived hostility of the world is irrational. You're not a mind reader and you don't really know what people are thinking. CBT would take your statement about being the target of hostility and ask you -- not to turn that frown upside down -- but to prove it. And if you can't prove it would ask you identify which brand of irrational thinking you were using (e.g. mind reading, fortune telling, minimization, catastrophizing, etc.) to support your irrational perception. Once that is named, CBT would ask you to therefore lay down your irrational conclusion and draw a new one that is supported by the facts. Even if that conclusion is a neutral one, where you can't make any particular statement about yourself, you have at least shed an unnecessary albatross you were hauling around.

If you find that you still don't want to let go of your conclusion, of your negative self perceptions even after you acknowledge that you have little or no evidence for them, that can be a useful starting point for some talk therapy. You're clinging to pain. Why? You must be getting something from it. What? Go find out. One thing you may need to do, which you won't want to do, is let go a little bit and let somebody else drive. You recognize that you have disorders that by definition involve irrational thinking, but you feel you are too smart/sharp/rational to engage in the treatments that have been shown to help. So there's a nice contradiction for you. Trust somebody else enough to let them guide you through it. And don't hold out and fight it just so you can feel in control or say I told you so. If you want to get better, swallow your pride, surrender some control, and be a willing participant in your treatment.

I recommend you read more about CBT. Go to a bookstore and skim through Feeling Good: The New Mood Therapy or Mind Over Mood. You won't find any special flower stuff. It's about management, not sunshine. Also read about other treatments such as exposure therapy, training, and medications. Look at lifestyle variables such as sleep, diet, caffeine, nicotine, alcohol, exercise, etc. And recognize that your depression is an additional factor to address, which may involve other forms of therapy or medication.

I can see that one of the things you're doing right now is playing out a scenario in your head to the nth degree, assuring yourself that it can't work without ever taking an actual step. You've jumped to a flawed conclusion about CBT, imagined yourself undergoing that fictional process, and have predicted total failure. There's so much going on in just that sequence that CBT could help with. Though you've allowed some window for us to talk to you about it, you've mostly ruled it out already. If you find that you are coming up with ostensibly reasoned excuses why nothing anybody suggests here or elsewhere could work for you (you special flower, you), consider that you probably need the objective neutral perspective of a trained professional. Good luck. Be patient. Keep trying.
posted by kookoobirdz at 9:04 PM on June 18 [7 favorites]

I'm very much of the nihilist/existentialist mode and CBT helped me a great deal with resisting anxiety triggers without having to buy in to some inauthentic sense of personal divinity or idealist philosophy. I haven't engaged with it in a methodical point-by-point way, but rather picked up a few skills and techniques that have helped me greatly without a holistic rationale informing each thing I integrate. These are things like: identifying thoughts and assumptions that trigger anxiety, shame, and frustration; practice at molding internal dialog dispassionately to interrupt anxiety; being mindful of physical manifestations of anxiety and performing physical techniques to counteract them (like breathing); goal building; and so forth. This book was well structured to, and encouraged the use of, choose-your-own-CBT-plans-of-attack. Maybe your exposure is characterized by overwrought self-actualization exercises and affirmations and mantras and other things that just don't make sense and have no appeal, but there are other directions to take. CBT can fit in just fine with a natural born skeptic, realist, relativist, nihilist, or other unorthodox philosophies. The insight into your own ways of thinking may even reinforce a critical and questioning outlook.

For example: Sartre's notions of bad faith and angst jive very well with CBT's explanation of cognition. But CBT gives some practical advice on mitigating these pitfalls whereas Sartre doesn't offer any model of personal actualization free of pain.

So yes, certainly it can help you.
posted by cowbellemoo at 9:11 PM on June 18

Clearly your perception of the kinds help available is one of the things being affected by your condition. Please speak with a doctor about what CBT or other therapies will involve. Anything you read in a book is going to be limited in its effectiveness based on the sole fact that you are alone in interpreting it. It's time to make yourself someone else's problem -- you've taken yourself as far as you can on your own.
posted by hermitosis at 9:16 PM on June 18 [1 favorite]

It sounds like you're equating CBT with affirmations. Think of it this way - you're already fantastic at doing negative affirmations: you have a constant loop in your head saying you want to cut yourself, kill yourself, you hate yourself and think death would be a relief.

That's a living hell, and no one deserves that.

What you want to do is replace the negative with something better. Maybe all this 'special flower' business is bullshit, but isn't bullshit better than the pain you're inflicting on yourself now? You know what you're doing now isn't working - hell, maybe CBT won't work either - but you owe it to yourself to try. Don't dismiss it before you even give it a shot. Talk to a therapist, tell them you're worried it won't work and see what they say.

You sound like an amazingly strong person to have come this far already, don't give up on yourself now. Best of luck to you.
posted by Space Kitty at 10:54 PM on June 18

Actually you have a good writing ability and have done a good job making progress from a challenging history. I friend you, anonymous.
posted by peter_meta_kbd at 10:59 PM on June 18

I hope you don't miss this, because I was you. I have social anxiety and I think looking at yourself in the mirror and saying, everyday, in every way, I'm getting better and better is absolutely crap.

I don't believe in special flower affirmations either, so CBT helped me quite a bit because it's not about repeating useless statements. This is the biggest thing I took away from CBT: the ten cognitive distortions. It's as far from special snowflake affirmations as you can get, as it forces you to recognise your own contribution to your misery.

# All or nothing thinking: You look at things in absolute, black-and-white categories. If you’re not a complete success, you think you’re a total failure.

# Overgeneralisation: You view a single event as a never-ending pattern of defeat. You may tell yourself, “This always happens,” or “I’ll never get it right.”

# Mental Filter: This is like the drop of ink that discolours the entire beaker of water. You dwell on one negative detail, such as an error you make, and ignore all the things you did right.

# Discounting the positive: You insist that your accomplishments or positive qualities don’t count.

# Jumping to conclusions: You jump to conclusions that aren’t warranted by the facts. There are two types:

1. Mind-reading: You assume that people are terribly judgmental and are looking down on you.

2. Fortune-telling: You tell yourself that something terrible is about to happen: “I just know I’m going to blow it when I take my test next week.”

# Magnification and minimization: You blow things out of proportion or shrink their importance. This is also called the binocular trick. When you look through one end of the binoculars, all your shortcomings seem as huge as Mt Everest. When you look through the other end, all your strengths and positive qualities seem to shrink down to nothing.

# Emotional reasoning: You reason from how you feel, such as “I feel anxious, so I must really be in danger.” Or “I feel like a loser, so I must really be one.”

# Should statements: You criticize yourself or other people with “shoulds,” “shouldn’ts,” “oughts,” “musts,” and “have-tos.” For example, “I shouldn’t feel so shy and nervous. What’s wrong with me?”

# Labelling: You generaliSe from a single flaw or shortcoming to your entire identity, instead of saying “I made a mistake,” you label yourself as “a loser.” This is an extreme form of Overgeneralisation.

# Blame: Instead of pinpointing the cause of a problem, you assign blame. There are two basic patterns of blame:

1. Self-Blame: You blame yourself for something you weren’t responsible for or beat up on yourself relentlessly whenever you make a mistake.

2. Other Blame: You blame others and deny your own role in the problem


Later on, another logical approach, ACT, also helped. The Happiness Trap talks about accepting that you will feel discomfort, and so what, will the discomfort kill you, and asks about whether the current techniques you're using are effective. It encourages to you to disengage from the feelings of anxiety and to recognise them as feelings, and perhaps not as the whole of reality, though it doesn't say so explicitly.

Oh, btw, Social Anxiety is my particular monkey, and CBT and ACT have both made a significant difference as well as certain drugs some of the time.

I've been to touchy feeling therapists, and I've been to CBT & ACT therapists, and I much prefer the ones who are a touch cynical like myself, and prepared to quietly debate my position on why I'm so useless, rather than tell me I'm wonderful. For example, how does it help me to think of myself as useless? Well, it doesn't, but it doesn't change the fact, that I'm no good. Does thinking of myself as useless hold me back from doing things I value? Yes, but that's because I don't deserve them. How do I judge who deserves what? Does everyone get what they deserve? and so on.

So how about this, finally. You've decided what you'll get out of a therapy session, without knowing what it entails. This gives you the opportunity to keep on being socially anxious, and the opportunity to pass on grabbing hold of life with both hands because you're scared. Funny, huh? You've convinced yourself that the most likely help won't help, so you won't do it, won't be helped, and will stay anxious. THAT is precisely why you need to either a. go see someone (and I do recommend that over books) or read David Burns CBT book and follow it up with Russ Harris's The Happiness Trap. A therapist will not let you "yes, but" whereas reading a book, you can convince yourself that you are a special little flower and this particular logic does not apply to you because you're more scareder, or more smarter than the average reader.

Memail me if you want more.
posted by b33j at 11:54 PM on June 18 [13 favorites]

The only counselor I ever respected explained how CBT works (I think). Basically, if your amygdala can't process a traumatic/stressful event it comes back to bite you in the ass. The only way to fix this is to talk it out with someone (it actually can be anyone as long as they're willing to listen and provide some feedback). If you need to talk about something too exstensively to reasonably ask your friends/family to help you with then you hire a psychologist.
posted by Pseudology at 1:12 AM on June 19

Social anxiety disorder is about feeling negatively judged by the world, completely against logic and common sense. Thus CBT would surely be aimed at changing my view of myself to be "better" i.e. not the negative object that is currently the target of the perceived hostility of the world.

Erm, no, CBT is about making your view of the world more realistic.

I have had CBT and it was nothing to do with positive affirmations. It was exactly what scody described above. Feelings come from thoughts, and the feelings of anxiety come from your negative thoughts. CBT helps you to sort out which of your thoughts are realistic and which ones are not, and reminds you to replace the unrealistic negative thoughts with thoughts that have a better basis in reality.

In short, you don't even know what the cure is, so why are you dismissing it out of hand?

CBT was great, it helped me with problems I didn't even know I had, and I think everyone should do it!
posted by different at 1:27 AM on June 19

But another way CBT seems to be presented is being about positive thinking - I am a special flower and deserve all the good yadda yadda.

CBT is about realistic thinking, not positive thinking. If anything, realising that you're not a special flower and that what you 'deserve' and what actually happens have nothing to do with one another is a pretty central tenet of CBT.
posted by obiwanwasabi at 1:32 AM on June 19

David Burns actually refutes the "special flower" pretty well in Feeling Good. If you're willing to agree that the "special flower" attitude has much in common with the "I'm WORTH it!" vibe, I wanna show you a little of what he says about worth.

"Acknowledge that everyone has one 'unit of worth' from the time they are born until the time they die.... when you are old or ill, relaxed or asleep, or just doing 'nothing,' you still have 'worth.' Your 'unit of worth' can't be measured and can never change, and it is the same for everyone.... Since you can't measure it or change it, there is no point in dealing with it or being concerned about it."

Then, a little later: "What problems do you confront today? How will you go about solving them? Questions such as these are meaningful and useful, whereas rumination about your personal 'worth' just causes you to spin your wheels."

His idea of self-esteem is your state when you aren't saying crappy stuff to yourself all day. It's not a matter of blowing smoke up your own ass, or pretending to be better than everyone else. It's a matter of knowing that you're worth just as much as everyone else, and vice versa.

CBT (from my understanding) is much less about repeating positive statements without any evidence, and much more about locating the negative thoughts and actually looking at them at face value.
posted by lauranesson at 1:37 AM on June 19 [2 favorites]

Look, a lot of people have offered more eloquent responses and clarifications than I could. I'm only here to echo them and give you that extra push (as someone else who suffered from social phobias). Many of your concerns are misconceptions. The fact is this isn't new-age woo we're talking about. It may or may not help in your particular case, but the scientific evidence supporting its efficacy is fairly convincing. That link is a metaanalysis of studies that were notably placebo-controlled showing a fairly consistent benefit across studies, which suggests that despite subjects' inclination to "believe in" the therapy or not, it still appears to be helpful. Moreover, it's unlikely to hurt, and based on the potentially crippling severity of anxiety disorders, I think the risk-benefit analysis weighs heavily in favor of at least trying what's out there. You owe at least that much to yourself, my completely unspecial snowflake.
posted by drpynchon at 6:00 AM on June 19

You might respond well to some of the other evidence-based therapies if basic CBT bothers you for whatever reason.

DBT, which includes mindfulness training and distress tolerance, might be useful for you. It has also been shown to be effective.

The most important thing is finding a therapist who will be structured and move you towards a goal, someone with whom you have a good rapport but not someone who is going to sit there and simply "support" you. You need/want more than that I think.

I'm not a mental health professional but I have some experience with similar problems. Could you memail me or email me at kathrinegutierrez at gmail? You can just send me a blank email with "mefi CBT question" in the subject line and I'll write back.
posted by kathrineg at 7:01 AM on June 19

Additionally, I will not be able to respond until tomorrow evening as I am traveling today, so don't worry if I don't respond today.
posted by kathrineg at 7:03 AM on June 19

Nthing everyone that there is no "special flower" stuff in CBT. It's about identifying your bad thoughts and disproving them by replacing them with a realistic thought.

Here's a practical application of what I learned to do in CBT: I was in a bad mood yesterday, sitting on the couch thinking I was worthless because I lose all my friends, and was starting to get really focused on that. I realized what I was doing and tried to prove and disprove my thoughts logically.

• Proof for: I'm sitting on the couch by myself, and have for many nights this month.
• Proof against: an email box full of messages from friends who aren't gone, just busy with their personal and professional lives as much as I have been lately. Just because I'm not seeing them in person as much doesn't mean they still aren't my friends.

So, replace that bad thought (I'm losing all my friends) with a more realistic thought (I'm pretty busy, as are my friends, so we should really make a point of hanging out) My mood improves somewhat, and I realize I can make it a better mood by just quickly sending out an email saying "lets do something this weekend"

Yeah, it's a simple example, but it's a real example. No special floweriness at all. No positive affirmation. Just a reworked thought, and a change in environment planned for the future.

A good therapist is there to walk you through the process of identifying what the biggest baddest "trigger" thoughts are, and to help guide you to disproving them. It can be really hard at first without the help. The goal is to make it easier for you to do on your own.

Check out Mind Over Mood. It really helped me during my bit of therapy, and it's a good book for when you need a refresher before things get you going down again.
posted by cathoo at 7:28 AM on June 19

From Of Matter and Forces in the Physical World, by Abraham Pais, an anecdote about Nils Bohr, one of the founders of quantum mechanics:
A visitor to the Bohr country home in Tisvilde noticed a horseshoe hanging over the entrance door. Puzzled, he turned to his host and asked him if he really believed that this brings luck. 'Of course not', Bohr replied, 'but I am told it works even if you don't believe in it.'

You sound like a smart person who has learned a lot more than most of us about how to think about and deal with the less rational parts of your mind. My guess is that even if you do run into the special flower stuff as part of CBT (and from the comments above it doesn't sound like you are likely to) you should be able to extract what is valuable from the experience and grow from it. And probably you will be able to develop your own framing and rationale for what happens.
posted by Killick at 8:24 AM on June 19

Agreeing with pretty much everyone else. The goal is to replace your irrational thought patterns with rational ones. Not equal-but-opposite positive ones.

I never did it formally, but I did use this sort of technique with a problem I had. I was having problems prioritizing things. I was stuck in a pattern of making my own comfort/pleasure outweigh my responsibilities. Like at work, I'd inappropriately prioritize a task where I would interact with people I liked ahead of more important, and unpleasant, tasks. What I did was taught myself to notice when I was having one of these conflicts, and to disengage my emotions from the equation. "How would I handle this if I was managing someone else's activities?" From that perspective, it was almost always obvious what the right choice was. I would then simply do that. Instead of getting positive reinforcement from doing a pleasurable task, I got the positive reinforcement from having made a good decision and doing the right thing.

So, for me, it was simply:

- Recognizing the weirdness.
- Defining the problem.
- Acknowledging the bad feelings, but also acknowledging my responsibilities.
- Acting accordingly.

Now, this was a fairly easy case. But serves to show that we do have immense capacity to "think ourselves out of a problem". The downside of changing the way we think about things is that it is hard to do. We get that uncomfortable brain cramp learning new stuff feeling. Just like learning division in grade school, you kind of have to trust that you are doing it right until the brain connections are solidified and you have actual understanding.
posted by gjc at 8:53 AM on June 19 [2 favorites]