What kind of therapy do I need to stop beating myself up

April 25, 2021 8:34 AM

I berate myself for dumb things I did years and years ago. I'll remember doing the dumb or wrong thing and immediately have this reaction and (sometimes verbally) berate myself. This has been going on my whole life. I've been to a lot of therapy but apparently not the right type to stop this from happening. What kind of therapy do I need?

These particular examples are a decade or more old, but things that are newer and much older get me too. This is far from a comprehensive list, just examples of the shit that gets in my head:

• When I was 18 telling everyone I was going to be an astronaut.
• Running into a professor on campus and accidentally calling them by the first name instead of "Doctor" or "Professor".
• Telling a really obvious lie to a supervisor.
• Visibly moping around the house because of an unrequited crush I had on a housemate.
• Drawing a giant pine forest instead of deciduous trees in an essay I wrote about Connecticut in second grade (my teacher's criticism was that Connecticut does not have giant pine forests).

(I don't need reassurance that these particular examples do not warrant me beating myself up for the rest of my life--I'm aware on an intellectual level, just can't make my emotional reaction stop)

Most, but not all, of the time this is in regards to social situations. I am pretty socially awkward. Also, I think there is definitely an element of rejection sensitive dysphoria in play here (I have ADHD).

I can't live like this anymore. How do I stop it?

(I am medicated for depression and ADHD, stable, and not suicidal. I don't actually self-harm when I think of these things but I sure do want to. I don't think this is OCD or anxiety because I have no other symptoms besides this)

posted by socks_for_all to Health & Fitness (16 answers total)

It would be helpful to know the styles of therapy you have tried and not found success with.

But off the top of my head have you tried psychodynamic therapy? It’s maybe more flexible and could help you tease out and examine memories and feelings in a supportive manner.
posted by Mizu at 8:43 AM on April 25, 2021

Response by poster: I've tried CBT, family-oriented therapy (where they analyze your family?), and lots of non-specific let's-talk-about-your-past-and-your-last-week-type therapy with many different therapists.
posted by socks_for_all at 8:49 AM on April 25, 2021

My anxiety manifested in perseveration. Exactly like what you experience. I found relief through CBT, talk therapy, and medication (specifically, generic sertraline). My therapist and I came up with a technique that helped a lot: whenever I start perseverating, I must repeat to myself that it is in the past and there is nothing I can do to change the past (I repeat it maybe two or three times), and then I need to engage in some other activity that uses my brain (like reading or listening to a podcast or digging into a data problem at work). The idea is to give yourself forgiveness and then force your brain to switch tracks. It works for me.
posted by cooker girl at 8:58 AM on April 25, 2021 [6 favorites]

Try DBT. You'll learn some concrete skills to interrupt the perseverance before you go down the shame spiral and redirect/reframe your thinking, and/or how to just let the bad feelings wash over you and feel them briefly without dwelling.

(I do this too. Nothing helped before DBT. Stopping the shame spiral is honestly more of a skill to practice, I think, rather than a "let's talk about this for hours and process it" thing.)
posted by nayantara at 9:08 AM on April 25, 2021 [6 favorites]

Oh, anxiety meds helped too. Taken as needed, only when I am unable to successfully interrupt the memory before the shame spiral starts. Over time as I've mastered the DBT "toolkit", as it were, my need for the anxiety meds has dramatically lessened.
posted by nayantara at 9:10 AM on April 25, 2021 [1 favorite]

I know you don't think it's OCD but this sounds like rumination, a very OCD style of thinking. As the link breaks down, rumination is not just a thought process, but a compulsive behavior. Some part of you may be dwelling on these incidents in an effort to 'fix' or reverse them.

This is not a diagnosis obviously, but looking into treatments for different kinds of mental illness might shed light on your particular brain situation, even if you don't actually have that diagnosis. In terms of treating it the other suggestions you've received-- DBT, meds-- will hopefully help you reduce these thoughts.
posted by coffeeand at 9:29 AM on April 25, 2021 [11 favorites]

Hello from an ADHD + RDS old-timer. I lived 45+ years with undiagnosed & untreated ADHD and have a giant list of similar shame-spiral triggers.

Tara Brach's guided meditation on healing shame has helped me immeasurably and in a surprisingly short amount of time.

Here's another similar video

A mindfulness-based therapist might be helpful for you.
posted by i_mean_come_on_now at 10:35 AM on April 25, 2021 [9 favorites]

This reminds me of a teaching by Thich Nhat Hanh on hungry ghosts. The video talks about ancestral ties, which may or may not resonate with you, but the upshot of the practice (described at 13:34) is this:

When these feelings arise, visualize the past you that experienced these things as if that were a different person. Extend to that person unequivocal acceptance and compassion.

For instance, say to second-grade you: I see and feel your pain! You were carried away with creative enthusiasm with your task, and that teacher’s critique, which should have furthered your learning, made you ashamed. Anyone would feel bad in such circumstances! But making this error wasn’t a sign that you are unteachable! Everyone stumbles when learning to walk.

Basically, flip the script. Take your intellectual insights and use them to salve the emotional wound. Repeat as necessary. Best.
posted by Rube R. Nekker at 10:43 AM on April 25, 2021 [15 favorites]

My therapist recommended me this book last week. Haven’t started it yet but the reviews seem promising.
posted by wowenthusiast at 11:42 AM on April 25, 2021 [1 favorite]

It's not a "kind" of therapy so much as telling the therapist about this specific thing and tackling it as a therapy project. If there is a dimension of rumination about it, you may need to be extra specific about how frequently it happens and the intensity of your response, because if you just say "sometimes I feel cringe about things that happened in the past" with no indicator of severity you're likely going to get a response of "oh yeah, the 3am thing, everybody does that, here's a very basic strategy to manage what I'm interpreting as a mild side effect of anxiety/human existence".

I do think you can get a lot of help from the books and videos recommended here too, though, in part because part of the treatment for this issue is destigmatizing it. Even Brene Brown, who kind of irritates me as someone who has turned Nice White Lady Storytelling into a Leadership(tm) brand, has some relatable and also sciencey material about shame that fits conveniently in 18- or 80-minute productions for TED and Netflix or whatever. It is useful and probably necessary to embrace the understanding that this particular feeling is normal human behavior and neurology but in a lot of us it runs amok and needs conscious management.

You may very well need to combine targeted therapy for this with medication. There is a brain chemistry cycle in these experiences that sometimes can't be managed until it is disrupted.
posted by Lyn Never at 1:18 PM on April 25, 2021 [1 favorite]

I have Tourette Syndrome and get this as well. The thing is, it really doesn’t feel too different from a tic, in that my parasympathetic nervous system (PNS) is being activated by an involuntary response.

This is absolutely a neurological phenomenon that is similar to those experienced by people with all sorts of disorders.

Do you necessarily check all the boxes to receive one of those diagnoses? Maybe not. But that does not change the fact that this belongs in the realm of intrusive / compulsive / obsessive thinking linked to your nervous system versus the logical thought happening in your brain’s cerebral cortex.

Look into coping mechanisms for calming the PNS. Examples include progressive muscle relaxation, circular breathing and EFT. You can try googling coping mechanisms for an anxiety attack as they are very similar.
posted by Juliet Banana at 1:49 PM on April 25, 2021

Seconding that this sounds like rumination. There are indeed therapies that directly target rumination, both as a part of "regular" anxiety/depression and OCD.

Just based on what you wrote, I wouldn't totally write off OCD, as self-punishment can be compulsive, as can non-traditional "compulsions" like research, reassurance, mental review, "checking", repeating things to yourself, etc. You can also absolutely have intrusive thoughts about something that has actually happened.

Mindfulness-based therapies like ACT can also help, though not all ACT therapists are great about making the distinction between a thought occurring to you (involuntary) and thinking about the thought (voluntary). It can even be a slightly fuzzy distinction in practice. Also, I think "values" work can be challenging if you are prone to interpreting them moralistically, i.e., you're not at a place where you can stop berating yourself for not having acted in line with your values, or obsessing about "the right way" to follow your values. Good ACT therapists will help you parse that out but it's something to watch for.
posted by en forme de poire at 2:03 PM on April 25, 2021 [1 favorite]

In my experience, who the therapist is and how you click with them matters a lot more than what the type of therapy is officially called. A good therapist will work with you to figure out what helps and be able to with with multiple styles. Different people are different, but to me starting with choosing a type of therapy before choosing a therapist is like trying to figure out the optimal method to cook food before deciding what kind of food you want to eat or choosing a recipe. People will be like "Grilling is the best! I grill all the time!" But maybe you'd rather have soup?

I'd look for people with experience with anxiety.
posted by medusa at 3:27 PM on April 25, 2021 [3 favorites]

Sounds like you could really use some self compassion.

This is a start: https://self-compassion.org/wp-content/uploads/2015/12/self-compassion.break_.mp3
posted by EarnestDeer at 1:39 PM on April 26, 2021

I was reminded, thinking about this last night, that one of the techniques I was introduced to for this kind of bad-memory-flashback, a long time ago, is a simple form of something like "reparenting" in which the Now You reaches out to the Then You for a dialogue of reassurance and reframing.

This is definitely the same spectrum as self-compassion and you will have have to muster up the same sympathy for the You who did the embarrassing thing as you would for a dear friend beating themself up over something similar.

I think part of what makes these burn so bad is because of the overwhelming vulnerability in those moments. Part of what is so upsetting is not the details of what you did but the intensity of the hurt that drove the action in that moment. Your primitive brain finds it hard to believe a pack of hyenas didn't take you down right there, you were so exposed and raw and out of your element.

Try having a conversation with Then You about their fears, inexperience, insecurity in that moment that led to the behaviors in question. Talk about how they may have been let down, in some cases, by someone who could or should have helped or made it easier for you or provided sufficient information or kept you safer. Advise them that you get better at handling or avoiding those situations, that it's not like that moment forever, and that it has lingered all this time and both of you should let it go. It may take more than one of these conversations; it may take you a while to really feel the full dose of care and understanding that the person in that moment needs to move past it. Give that version of you the same solace you would a friend.

I still think external help is especially useful in these cases, but they're almost certainly going to ask you to engage with the place and time and who of that moment, so it's okay to have tried that out beforehand.
posted by Lyn Never at 2:21 PM on April 26, 2021

OCD is often overlooked. Being evaluated by a specialist could be eye opening. OCD specific treatments, such as Exposure and Response Prevention, can effect powerful change very quickly.
posted by batbat at 7:58 PM on April 27, 2021 [1 favorite]