Should I try CBT for a third time?
January 6, 2012 6:25 AM   Subscribe

CBT questions: Can cognitive behavioural therapy work for me if I've tried it twice without success? Don't feelings happen before thoughts? Aren't some beliefs deeper than rational thoughts can change? What if you don't have the will to do homework?

Headline summary: male, 36, low self esteem, fear of rejection, fear of intimacy, never had a girlfriend, no close friends, never had sex, burying my head in books, very lonely, sexually frustrated; economically functioning but missing some essential human capacities and experiences.

I've tried CBT twice, first when I was 28, then again when I was 35, neither time was beneficial. The first time it seemed like I was getting wise advice but didn't make use of any of it in practice.

The second CBT attempt was 3 sessions when we spent the whole time discussing theory of CBT without me being persuaded of how it worked. That therapist gave me the name of her mentor whom she thought would be better, but a year later i still haven't called her.

Between 32 and 35 I spent 3 years at talk therapy ('integrated therapy') once a week, which gave me some insights starting from a very low base (knowing what feelings are, knowing that awful feeling is called loneliness, understanding causes are self esteem problems and fear of rejection) but didn't change how I felt or what I did, and I just got too frustrated with the lack of improvement and quit.

So for the last year, no therapy and no improvement.

I'd like to do something about how I feel and how I live, I don't want to take drugs, I have this 'lead' of a recommended therapist, I know there's published evidence CBT works and I know non-directive talk therapy didn't do a lot for me. But it is expensive and I'd like to know there's a decent chance it will work. SO my questions are:

(a) Can my thoughts really control my feelings and beliefs? I can control my actions with thoughts, but I can't stop the feelings with thoughts. for example, if something is said that hurts me, I can know it's not intended to hurt, I can know I shouldn't be hurt by it, I know it's absurd to be hurt by it, I can (almost) act as if I'm not hurt by it, but it still hurts and I'm still in pain. Also, beliefs seem deeper rooted than rational thoughts you can argue at a rational level with someone until they have no more answers, but that won't change their fundamental beliefs (that's my experience of politics and religion anyway): my belief in my own worthlessness and my belief that rejection will be very painful are pretty fundamental.

(b) CBT takes 'work': what if your problem is that you don't want to do that work? Whatever I think the work might be, I don't want to do it: I don't want to talk to strangers, to put myself in vulnerable positions, to do lots of small talk with random people, to get some rejections. Also, I don't see the point of writing a journal of things I should think when that's honestly not what I do think, and even if I could think it, as I said above, that wouldn't change my feelings. It seems to me that such therapy can work if you are 95 per cent of the way there already and just need a little push to get you over the hump. I do want to get better and do want to give it my courage, effort and ability, but what if I don't have the courage or discipline in the first place?

Have I misunderstood something about CBT?
Have you tried a few CBT therapists and then found one that did work?
Am I a bad candidate for CBT and if so what would you suggest?
Have you tried another form of therapy that worked in less than three years?
Thank you
posted by anonymous to Human Relations (30 answers total) 15 users marked this as a favorite
The short answer is a.) Yes, it can work but
b.) you have to do the work.

Nobody else can do it.

A good start for one in your situation is David Burns' book, "Intimate Connections." But don't just read it, do the work.

Good luck, you can do it.
posted by fivesavagepalms at 6:43 AM on January 6, 2012 [3 favorites]

While CBT is intended to recognize and to sometimes hold at arms' distance and to "think about thinking," and, in shorthand, to retrain your brain, I think you (or your practitioners) are misconceiving part of this. You're not going to "think away your feelings." Instead, you're supposed to feel and experience your feelings, in-session, in a place without repercussions. The goal being to get angry, to be sad, to be all these things, and to let that experience, that expressed emotional life, guide you (retrain you, I suppose) into being a productively emotional person.

Your self-description here is so miserable. Surely there's more to you than that. Start by not-defining yourself like that, maybe! Jeez buddy! You're a well-read guy in the prime of his life who's employed and a successful member of society.
posted by RJ Reynolds at 6:47 AM on January 6, 2012 [4 favorites]

If you don't want to... don't do the work... outside of sessions no therapy is going to do you any good. CBT, or really anything else, is not a magic bullet. Frankly I don't see how you can say 'it doesn't work' when you haven't actually done the work. You can go trough 10, 100, or a 1000 therapists but if you don't work it you might as well see no one.

I understand you don't want to put yourself out there for rejection, and you don't want to take drugs, but at some point you have to accept that either you risk some emotional involvement or you accept yourself the way you are, or you just stay locked in the place you are at. If you are as miserable as you say you are, nothing short of a radical change (even in small steps) is going to make a difference, if you are too afraid to make that change (even in small steps) and are unwilling to follow trough with the actual hard part of therapy you are in a pretty tight spot.

FWIW, it kind of sounds like you are locked into over thinking the process rather than doing the process.

Good luck
posted by edgeways at 6:48 AM on January 6, 2012

You're kind of asking about a course of treatment in which you don't want to participate. It's like saying, "Physical therapy can help my back pain, but I have no intention of doing the prescribed exercises, will it still work?"

No. No it won't, unless you do the work. Just signing up for something doesn't fix things.
posted by xingcat at 6:55 AM on January 6, 2012 [3 favorites]

Yes, you can actually stop feeling the feelings eventually, but only if you do the work. For example, you can actually stop hurting when you hear comments you know are not intended to hurt you. You will not reach that point unless you do the work.

Here is a comment I wrote before about depression which touches upon why this is the case; many people have told me this was the sort of convincing they needed to understand why things don't automatically work and work forever, and it helps give them faith to keep working at it. If you are similarly-minded and find it helpful to have things explained in a more physical, this-is-what-your-brain-needs-to-do way, that might be helpful. In short, you need to build up new pathways in your brain while letting old ones die off, and that is a literal physical process which takes time. Your brain cannot build those pathways if you are not doing the work, because it only builds pathways based on what you are paying attention to, and to the degree you are paying attention to it. You cannot internalize things without time and effort; if you could, no one would be depressed! The reluctance and fear of failure or wasting time that you are experiencing now is built on years of your building up the pathways that lead to those thoughts; you have felt bad for a long time, and it will take time to feel good. Starting can be the hardest part, so it feels really shitty right now. It will probably take you years, but you must do it. You can do it.
posted by Nattie at 6:57 AM on January 6, 2012 [3 favorites]

On one of the other questions, someone said something very useful - that your mind loves stasis and wants things to stay the same, even if the same is awful and painful. I suspect that part of why you "don't want to do the work" is your brain undercutting you (so to speak). As long as you don't do the work, the therapy won't work and you won't change.

Change is really scary. That sounds like a bunch of new age crap to me, honestly. But I have found it to be true. When I have grown out of or let go of bad coping strategies, I have sometimes looked at myself and said "I don't know who I am anymore, now that I am not the Person Who Can't Talk To Strangers, the Person Who Can't Take On Responsibility, the Person Who Is Attracted To People Who Can't Love Her". And it's scary. I can only assume that my brain does not want me to cope with things because my brain is more scared of change than of bad habits.

As irrational as it is to separate "me" and "my brain" (really, that totally makes no sense) I have found that this helps. "My brain" wants me to have a panic attack instead of doing work; "my brain" wants me to skip going to an event rather than going and seeing my friends; "my brain" wants me to believe that my crush on Unsuitable Person is karmic and fated rather than part of a bad pattern. I want to make better choices.

Anyway, "your brain" is fucking with you. (Or think of it as "your unconscious", or "that part of you which is your hurtful impulses" if that helps.) It has you right where it wants you - unable to move, unable to change, doubting the only available solutions so much that you can't even try.

Something that sometimes helps me a bit is trying new things whenever I can - often very small things. Listening to new music, walking a new route, going to a different grocery store, trying something I'm not sure I'll like. Small changes sometimes shake me loose enough that I can try to make bigger ones.
posted by Frowner at 6:59 AM on January 6, 2012 [17 favorites]

I've been in therapy for about 3 years. I don't feel like I've ever had to work at it, other than going to the appointments, which definitely has felt like work at times, and I've definitely never done homework. So it surprises me to hear that in your therapy experience, anonymous (and others, it looks like!), you feel like you've been advised to do things like talk to strangers or make yourself vulnerable. For me, those things wouldn't help at all!

My therapist listens to me, and basically repeats what I've said back to me, and sometimes makes connections with things that she knows about my past. This experience works incredibly well for me. It helps me trust myself and it makes me feel validated, which are probably the reasons I came into therapy in the first place: I didn't like myself and felt anxious and guilty all the time. I also tend to be REALLY hard on myself, which it sounds like you might be as well? And she helps me immensely with that. But I think the key to the whole process working is finding the RIGHT therapist. I was in therapy with other therapists before (I tried maybe 3 or 4 at different times in my life), but this is the only relationship I've stuck with. The process of finding the right one sucks so bad, but it's worth it in the end. And timing--I think that matters, too. I don't think I was ready to change my habits before (of being hard on myself and such), but apparently I was ready to three years ago.

I apologize if this comment doesn't help you at all or wasn't what you were looking for. But if it was, and if you have any questions, feel free to email me--it's in my profile. Good luck and best wishes!
posted by lagreen at 7:05 AM on January 6, 2012 [2 favorites]

Whoops--I forgot to add that, in the past, when I wasn't on the anti-depressant that I'm on now (Celexa, 20 mg--so nothing too heavy), everything seemed much harder. The combination of talk therapy and anti-depressants has worked best for me, and I think research shows that it works best for others, compared to either treatment alone. I completely understand your not wanting to be on meds, but I didn't feel like my response would be complete without this little statement. :)
posted by lagreen at 7:09 AM on January 6, 2012

I wanted to add, I know it can feel way ridiculous to spend time repeating positive thoughts, or feel stupid to sit down and write out your feelings, but seriously, yes, it will help. I know it feels dumb.

I recommend the book Flow by Csikszentmihalyi if you want to be thoroughly convinced of the merit of how sitting down and paying attention to something as opposed to something else is supremely effective. At the very least, any time you're not thinking "oh my god I'm a worthless piece of trash" (or whatever your personal refrain may be) is time you're not reinforcing those pathways. This line of thinking has really helped me a lot, because it's not very esoteric or touchy-feely, and strikes me as indisputablely true; if I were to distract myself from ever thinking those things, I would not feel they are true. By definition, really.

Of course the benefit of CBT is you give yourself new, healthier pathways to use an alternative. This really speeds the process up because, as I'm sure you know, once you're in the habit of being down on yourself, pretty much EVERYTHING you try to do or think about someone leads back to how you're just irredeemably awful or life is irredeemably awful or whatever. That's part of what makes CBT difficult to start, because you're generally dealing directly with your awful feelings so you can't entirely take your attention off them, and it's easy to just get more deeply depressed doing the exercises sometimes. I know it's hard, but just keep doing them. Keep reminding yourself and accepting that it's hard and keep trying. You will get to a point where you can sternly tell yourself no, you're not allowed to feel like shit right now, and logically remind yourself why it's unproductive, and finish an exercise more or less successfully. Things will get easier (usually with some setbacks) from there.
posted by Nattie at 7:09 AM on January 6, 2012

CBT is not for everyone. I'm not saying you need meds but have you tried meds at all for any of your issues or just talk therapy?
posted by dgeiser13 at 7:19 AM on January 6, 2012

CBT definitely takes work outside of sessions, so if you're not ready to do that then I would advise not starting. However, if you're just very AFRAID of the work, then maybe be really honest with your clinician and know that you will need to push yourself. A good clinician will challenge you, but won't make you start with your #1 feared can work your way up (this is not the same as saying "you will be allowed to move so slowly that it will never be uncomfortable." It WILL be uncomfortable at times, you WILL need to commit to doing the homework/exercises even when you don't feel like it or think they are kind of dumb).

Also, you seem to be focusing on the "C" (cognitions) part of CBT, but the "B" (behavioral) is a HUGE part of it. Yes, you do the rational-thinking piece and that is important, but your therapist will also challenge you to go out and DO things (behavioral experiments, exposures, etc) to test those beliefs and create new learning. This is where you get at those "deeper rooted" things you mention -- by actually experiencing the real outcomes and realizing that your beliefs were not accurate. This is a very meaningful and powerful way of learning; CBT is not just "think happier thoughts," it's more "assess the objective evidence and then test it out in a real situation."
posted by Bebo at 7:34 AM on January 6, 2012 [1 favorite]

With regards to (a), you can't chop a tree down with just one blow of an axe. If you're expecting to understand the problem and have that cure the problem, then you're looking at it in the wrong way. The feeling of pain is a conditioned response, and they don't go away just because you understand why they're there. You have to create a new conditioned response to override the old one. You do that by following the ABC process and challenging your negative thoughts.

Some thoughts are going to be more resistant than others, but in that case, you just have to keep on chopping at the tree. If you've had a conditioned response for 20 years, then it's not going to go away overnight. If you haven't gotten to the "deeper level", you just haven't dug far enough down. Your experiences of arguing politics with other people is a red herring - with CBT you're trying to change your own mind, not someone else's.

With regards to (b), you have the conditioned response that it's not going to work. Is that why you're not trying, perhaps? You seem to be starting with the assumptions that it's not going to work and that you have to put yourself in unpleasant situations before you're ready. Right now, try focusing on experiences that you've already had, where you've been rejected. Don't go courting rejection until you're prepared to deal with it.

Perhaps you need to start in a much smaller way that you think you have to. Maybe you're magnifying the amount of work you need to achieve? Maybe you're overgeneralising, based on past experiences? Think about what you wrote in (b) and try to spot the errors in that.

CBT works for a lot of people. Statistically speaking, there's a good chance that it will actually work for you. If you just want to look for fake evidence that it won't, though, then that's your right. Don't say it doesn't work, though, until you've actually tried it. It might be that your brain is unique and CBT will be completely useless. That's very unlikely though. Of course, you have to put the work in rather than just giving up after a few half-hearted attempts. And there will be times when it's difficult to see what is going on. But you have access to a good therapist who can help you with that, and the rewards can be immeasurable.

Put the work in. Even if it doesn't work, at least you'll know. The alternative is continuing as you are.
posted by Solomon at 7:48 AM on January 6, 2012 [2 favorites]

Can cognitive behavioural therapy work for me if I've tried it twice without success?

Yes. Like others have said above, you have to do the work. If you didn't do it the first two times then of course it could not have been effective.

Don't feelings happen before thoughts?

The way I understand it, feelings are thoughts as well. They might have more of a physical, and less of a verbal quality, but they are still thoughts and you can work with them as such. Also, I think that the more you investigate your feelings and become familiar with them, meaning you resist them less and are able to look at them, then you can often find the underlying words or images that are connected to the feeling and they become even easier to work with.

Aren't some beliefs deeper than rational thoughts can change?

Personally, I think that even the tiniest bit of doubt can start to erode beliefs that you've had all your life. When you do the work you will be investigating yourself and that will most likely lead to some new realizations about why you believe what you believe, and how those beliefs might be flawed. It reminds me of an analogy I heard where a necktie is coiled on the floor in the corner of a dark room. A man is convinced that it's a snake and is terrified. If he turned on the light or opened the door a bit more he would see that it was nothing more than a necktie, but instead he continues to believe that it's a poisonous snake and lives in fear... something like that.

What if you don't have the will to do homework?

Think about the benefits of doing it. Then do what you can, and forgive yourself for what you can't or are unwilling to do. Focus on what you are willing to do and whatever that is, do it really well and give it your all.

I don't want to talk to strangers, to put myself in vulnerable positions, to do lots of small talk with random people, to get some rejections. Also, I don't see the point of writing a journal of things I should think when that's honestly not what I do think

I didn't do these things in CBT and I wouldn't have wanted to either. I recently shared in a comment a few of the exercises I learned while in therapy, you may find them of interest.

Good luck to you!
posted by seriousmoonlight at 7:58 AM on January 6, 2012 [3 favorites]

"Don't feelings happen before thoughts?"

Yes, feelings happen before thoughts - and thoughts happen before feelings. It's a cycle. Here's a typical example:

1) You have a bit of a chemical imbalance, perhaps your seratonin levels aren't quite right, and it leads to feelings of sadness.
2) Your rational brain, which is really a rationalizing brain, tries to justify the sadness: "I feel this way because I'm such a loser."
3) Naturally, thinking of yourself as a loser provokes even more feelings of sadness.
4) As the feelings intensify, your brain comes up with more bogus explanations: "Everybody must really despise me because they know I'm a loser."
5 - ∞) The negative feelings and the negative thoughts feed on each other and become habitual.

Once the distorted negative thoughts become habitual, then they can pop up and take over even if the original chemical imbalance isn't active at the moment. For example, you might have found an anti-depressant which fixes your seratonin levels, but a friend makes a comment which you know isn't meant to hurt you but reminds you that you "know" yourself to be a miserable failure who can't do anything right and that sets off another cycle of negative feelings and thoughts.

That's why it's most effective to short-circuit the viscious cycle from both directions. Tackle the physical feelings with medication, exercise, sunlight and good sleep habits. Tackle the distorted cognitions with CBT or any other approach which can help you develop happier, healthier, and more realistic cognitions and perceptions.

It will take work. If you've been suffering from depression for a while, odds are you've "practiced" tens or hundreds of thousands of repetitions of thinking distorted negative thoughts. That's a lot of work building an ingrained habit and way of seeing the world. It may take a comparable amount of work to build healthier mental habits.
posted by tdismukes at 8:03 AM on January 6, 2012 [5 favorites]

You're in a tough position here. You sound really miserable, and your hopelessness is palpable.

I don't think you should bother with CBT again. What's the upside? All modalities of therapy work about as well as other modalities, so there is nothing magical (or more scientific) about CBT. It certainly does not sound like you have faith that CBT will help you, and it doesn't seem like it explains your problems to you very well. Why not try something else? (I know you tried something else before, but why not try something else again.)

Here is a comment I previously wrote about how to get the most out of therapy.

Good luck.
posted by OmieWise at 8:26 AM on January 6, 2012 [3 favorites]

From watching the experiences of a loved one, CBT is definitely, absolutely not for everybody. It may well be fantastic for people who are not comfortable examining their own thoughts and feelings or being particularly self-reflective, because it provides them a formal structure to learn how to do that.

It is terrible for people who already have a tendency to ruminate over every thought and feeling and can actually lead those people into even darker, more miserable places than they already were in.

It is okay to seek out other kinds of therapy, and it is okay to tell a particular therapist that CBT is not for you. It does not make you weak or lazy to not want to participate in a kind of therapy that you do not find helpful.
posted by hydropsyche at 8:28 AM on January 6, 2012 [4 favorites]

the overwhelming response here seems to be "you have to do the work," and i know how difficult that can be when you really just don't want to. here's what i do when i know i have to do something i hate:

- make it a game so it will be more fun. find the competition in it if that inspires you to "win"
- get a buddy (this is recommended when someone tries to quit smoking, lose weight, etc)
- start with small steps, and once you get used to it, it won't be as difficult
- find a prize for yourself after completing something you don't want to do
- mix it up. do a bit of each task instead of hours of just one thing
- visualize the process (step by step) through completion before you begin (i saw this on some healing show)
- use any negative feelings you might have in your life at the time to fuel the task. i take out my anger while punching the air with 3 lb weights. whoever i'm pissed at that day gets punched in the imaginary face :)
posted by carielewyn at 8:42 AM on January 6, 2012

You need a good therapist to start with. If you have a good therapist, the "work" will be work you want to do. By good therapist, though, I don't mean well-trained or experienced -- one hopes that most or all therapists are that. Rather, you need a therapist who you connect with and trust.
Find the right therapist for you.
posted by foxinsocks at 8:47 AM on January 6, 2012

I didn't find CBT helpful after a point; I found it rage-inducing and awful and I was never in a million years going to do that stupid homework, even if it meant I remained miserable. I moved to more general talk therapy that focused more on my beliefs and patterns and history and goals, and it worked wonders.

Don't keep doing something that doesn't work in the hopes of a different result, do something different! And please, do something. You deserve to be happier and healthier!
posted by ldthomps at 8:48 AM on January 6, 2012 [1 favorite]

It is a huge amount of work. But it sure worked for me.
posted by Ironmouth at 9:18 AM on January 6, 2012

If you believe that feelings precede and influence thoughts, you might feel more at home in Dialectical Behavioral Therapy (DBT). A social worker I know described the difference to me as something like, "CBT says that wrong thoughts give us feelings we don't like; DBT says that feelings we're upset about or afraid of give us thoughts we don't like. The result is the same: depression, anxiety, and acting out. But the treatment differs in terms of which one you try to conquer first to get at the root of the problem." See if you can find a DBT practitioner and talk with her/him about whether that might work for you.

That said, I do agree with the others above that you're going to have to get over your "not gonna do the work" attitude. Mental health treatment, like physical health treatment, requires your cooperation, and it sometimes requires you to put yourself through things you find unpleasant in order to reach a good result. If you're not going to take the "medicine," there's no point in "filling the prescription." But you can also discuss this attitude with a good therapist, who may be able to explore with you why you're feeling so anxious and afraid and unwilling to make changes in your life despite your unhappiness.
posted by decathecting at 9:36 AM on January 6, 2012 [2 favorites]

Finding the right therapist is a very important factor. If you're interested in change, having a therapist who makes connections you never thought of before and validates your feelings can be very helpful.

Very few people ever talk about shopping around for a therapist. It means that you have to be able to say "I don't think this is going to work" to the person you're talking with and that can be challenging. But it's important. It's your time and your dime. And your life.
posted by Taken Outtacontext at 9:45 AM on January 6, 2012

I have had a lot of success with Dialectical Behavior Therapy. Although my therapy was trauma focused, the program has been shown to help people in lots and lots of different situations.

It's still going to involve homework, but some of it is just observe and take notes.

Because it has a slightly different focus from CBT, I think it might offer you a fresh start after you've been disenchanted by the CBT. Be aware, like every comment above says, you do have to do the work, no therapy style works via osmosis.
posted by bilabial at 10:35 AM on January 6, 2012

(a) Can my thoughts really control my feelings and beliefs?

No. Yes. Well, maybe. One of the frustrating things about CBT--and any other formalized therapy--is that it is built on assumptions that have about as much to do with reality as Freudian psychoanalysis. They're working with metaphors. I mean, seriously, what's the difference between a thought and a feeling? I understand the mechanism, that the commentary your brain is doing results in emotion which results in further self-commentary, and it all just cycles around--but in my own experience, I found CBT an unsatisifying explanation of that, with too much focus on playing around with the commentary, as though I could somehow propagandize myself into feeling differently. The initial thoughts--the things that apparently spur the first bad feelings--must be so fleeting that much of the time they are invisible, unable to be caught, and if you're trying to write them down for homework, you get the sense you're only capturing a fleeting echo. Everyone else's experience of CBT may be different than mine, but for me, there kept being all this focus on the internal dialog, rather than on the idea that what I was reacting to were really bad things going on, and stopping those really bad things would've been more helpful than adjusting any illogical thinking about them.

But look at all those answers above. Obviously some folks get relief that way. I am a believer in examining thoughts and reactions pretty closely when it comes to panic attacks, as I had some success there...but for the depression? Not really.

(b) CBT takes 'work': what if your problem is that you don't want to do that work?

I sympathize with this absolutely. However, the truth is, it all takes work. Even if it's not CBT. Whatever you do is going to take work. Getting better will; even staying the same will--you feel like you're in a rut, but it takes a fantastic amount of energy to be down on yourself all the time. Depression is exhausting.

(There are, btw, other methods of using a journal to combat depression.)

Still, what is the work? What parts of the work do you just hate, and would it be possible to negotiate these with the (future) therapist? Because if you're trying CBT, and they're asking you to, I dunno, talk to strangers, maybe you find that too big and depressing a step. Maybe there's an intermediate step that would be easier, because maybe it has been too long since you were comfortable around people, and the amount of exposure you get at the beginning should be very tightly controlled.

And part of that control should be deciding what to expect. "If I take this step for a week, how exactly are you expecting I will feel differently, and if I don't, what's the back-up plan?"

Obviously that takes someone willing to work with you and work with your frustration with past therapy.

Oh, this wasn't much of an answer, and I'm sorry for that. I guess I just want to say, it's your depression, and you're hiring someone to help you, and they need to be willing to work with your limitations--not let you off the hook entirely so you just sit there and magically get better, because that doesn't happen--but to construct the steps more organically, so that what you feel and how quickly you can move, actually matter.
posted by mittens at 10:59 AM on January 6, 2012 [2 favorites]

(a) Can my thoughts really control my feelings and beliefs?
It's not really about controlling your feelings. Feelings are normal and nobody suggests it should be taken away. But the mark of mental illness is that when feelings escalate and interfere with one's ability to live. CBT hopefully helps you identify and do something to de-escalate and control your response

For example: it's normal to feel anger when somebody cuts you off when you're driving. One destructive response would be to get into road rage and slam your car against his. One step to de-escalate might be to instead yell at the top of your lungs. Not ideal - but way better than slamming cars. The next step would be to say cuss words. And so on.
Might not be the best example but I want to illustrate that there are different responses to a given feeling. Some more destructive than others. CBT hopefully trains you to develop 'proper' responses to legitimate feelings.

And as people have pointed out, it seems daunting to start doing big things especially where you feel vulnerable. But a good therapist should be able to guide you to start in small steps.

Here's the analogy: you're completely out of shape and overweight and you want to be able to do pushups. You can't do even do one and yet you think any personal trainer will yell at you and make you do push up after push up. Not that way. They'll start you out on wall push up first. Out of your comfort zone - sure, but you can do it. A month later, they'll get you to do inclined push up. A little harder but you're better prepared.
And then knee push up.
And finally, after months of training, will you get to do the actual push up.
Same thing with gradual exposure in CBT.
posted by 7life at 11:14 AM on January 6, 2012 [1 favorite]

I was in a very similar position to you, and I did manage to get my first girlfriend and have a successful sexual and emotional relationship with her, even at your age. It IS possible if you make the effort.

(a). Yes. Definitely. That doesn't mean you have total control over your beliefs and feelings. You change them slowly and gradually. It's not the same thing as trying to argue with someone else: you can't control someone else any more than you could make their arms and legs move by thinking about it, but you can control yourself. If you're doing it right, the things you're trying to persuade your subconscious about are true: e.g. that it really doesn't matter what a stranger thinks of you. You're not trying to give yourself false beliefs, or debatable beliefs, you're just getting your subconscious to accept what you know consciously to be the truth.

(b). I don't know quite what this means. If it means can you change your feelings without doing the work, the answer is no. You need to do the exercises, keep the diary of feelings, say the affirmations, talk to strangers, or do something. But there are different kinds of exercise you can do: if you talk to your therapist you might be able to find others if some are bothering you.

Finally, I don't think therapy on its own is necessarily the answer. You don't need to sit around and wait for therapy to fix you before you start relating to people. You can make an effort to talk to your neighbors or co-workers more, or join organizations and talk to people there, even sign up to a dating site if you're ready to face it. Therapy can help, but you need to concentrate on real life as well.

I only did one course of proper CBT, didn't find it that helpful, but kind of made my own program of self-improvement on similar lines.

Email me at remoqe (at) if you have any questions.
posted by Remoqe at 11:57 AM on January 6, 2012 [2 favorites]

some people don't find it beneficial. There are other therapies that are proven effective, even if they're not as famous as CBT. It depends what the source of your unhappiness is. Many people benefit from interpersonal therapy, for example, or acceptance change (more mindfulness based) therapy. CBT, despite the lots and lots of talking, is not the only therapy that studies show works, it's just the most recognized.
posted by namesarehard at 2:04 PM on January 6, 2012 [2 favorites]

CBT didn't help me at all either but I've always known that my problems were chemical, not thought-based. However, I did find that DBT was helpful and made more sense to me. Of course it also helped that I was in a group using horses. It is amazingly empowering to move a one ton animal just by poking it with your fingers.
posted by monopas at 4:44 PM on January 6, 2012

CBT can't solve everything, but it works from the theory that a lot of the chemical imbalance can be mitigated by training yourself to not think negatively. Look up cognitive distortions.

Very simply, it's like broccoli. Why do some people like broccoli? Because they like it. When they think of broccoli, their though patterns go something like "wow, broccoli, I am going to enjoy eating this" and then their mouths water and they feel hungry. And people who dislike it do the same thing, only negatively. They think of broccoli and start to have visceral reactions, their stomach turns, their mouths water in that "I'm gonna puke" way, and they maybe even think of all those times their grandmother tried to force them to eat it.

Positive or negative, it's all in their heads. CBT says that you should sit down and consider the broccoli on its own, and realize that broccoli doesn't really taste like anything, that disliking it might be more related to disliking grandma's way of making you eat it, and that you are doing yourself a disservice by hating it. That it takes FAR more effort maintaining the dislike than it would take to just sit down and eat some.

Another example: my mom hates peas. Naturally, my siblings and I developed a desire for them just to make her crazy. We decided to like them, maybe not 100% consciously, because we knew the outcome (making mom gag) would be pleasurable to us. CBT says to use that process for everything. We do have the power to change our perceptions, we just have to decide to do it.

The hard work of it is trying to be mindful of when these distortions are occurring. It's not a magic switch that you flip, but a process. You think of a stressful thing, you feel your face flush and you start thinking of ways to mitigate or escape the thing. What CBT does is teaches you to notice when that is happening, and stop those thoughts. As you develop this skill, your conscious "I have to stop thinking this way" thought patterns get further and further ingrained into your subconscious, until your first though and feeling when presented with a stressor is "how should I feel about this" rather than the automatic "I hate this" feeling. Once you get to that point, it becomes much easier to answer that question with some kind of positive. "How should I feel about this?" can be answered with "wow, this will be a challenge, but if I can just do X, Y and Z, I can overcome it and that will feel good. Even if I can't manage to overcome it this time, I will learn something and it will be an ultimately positive experience."

Because the alternative is the pattern of stressor to "I will hate this and fail at it". Which is true- if you let yourself believe you will hate and fail at something, your subconscious will do its best to make that a reality.

The other benefit of CBT is that it was designed (or discovered, depending on your frame of thought) to NOT have to be long term. As soon as someone has been trained to think like this ("why am I doing and thinking things that are detrimental to my happiness?" followed by "I may not prefer this aspect of this thing, but doing it leads to happiness, and that's what I will focus on when I do the thing"), they don't need to be in therapy anymore.
posted by gjc at 5:33 AM on January 7, 2012

The other nice thing about CBT is that it acknowledges that many people won't believe it works. You don't have to commit to believing it will work, you only have to commit to trying it. Because more often than not, just doing what is asked of you will be enough to make it work. You'll end up at a point where you notice you are happier and you'll say "holy shit, that really DID work, I wonder what other things I am convinced of really aren't true?"
posted by gjc at 5:37 AM on January 7, 2012

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