Struggling with CBT

[AnxiousMunchkin]

I have my 3rd of 6 CBT sessions tomorrow for anxiety & depression (mainly anxiety is biggest issue at the moment) and I don't feel like I'm getting anywhere. Last session the therapist said she wanted me to try behavioural activation, thing is I was so anxious and on edge at the session I don't feel like I really took much of it in and I didn't really understand what I was supposed to do.

First session I had to keep a diary of how I spent my time during the week. I went a bit overboard with colour coding etc for the first 4 days but then crashed and didn't manage it the second half of the week and scribbled a few things in as afterthoughts. This time I was supposed to plan activities in advance in 3 categories, necessary things, routine things and pleasurable things, and then stick to them. Thing is I already have detailed daily/weekly routines I aim for (housework/self care/to do lists etc) and not being able to do those things is one of my problems. Anyway I wrote the plan, but looking at it the only things I managed to tick off on it are things I couldn't not do without letting people down, like appointments/things that involved other people. Things that were just me, I wasn't able to do. Like always. That's why I've asked for help. I already know I needed/wanted to do these things so what was the point of me writing a nice week timetable plan of them pointing out to myself that I fail to achieve these goals?

Behavioural activation seems to be telling me to do things anyway and then I'd feel better, well if it was that easy I wouldn't be asking for help in therapy?

I feel confused and like I'm failing and wasting time in therapy. I already apply lots mindfulness and CBT techniques (learned from self-help books and online courses like mood gym) and right now can't see why I'm putting myself through this appointment tomorrow which is making me feel worse.

Has anyone got any insight or just words of encouragement about all this? I feel pretty hopeless right now.

I found CBT really difficult at the time but ultimately helpful.
Choose less! It's easy to be overwhelmed or anxious when you have a list of 21 necessary, 12 routine and 10 pleasurable things to do!
I do stupid things like put in go to the gym which covers all three for me. Singing in the car is a pleasurable thing but takes no actual time.
What can wait or be delegated?

Clearly almost everything can wait, without the world actually ending, because it is at the moment. But I'm stuck in a fairly unpleasant environment, avoiding people and situations, not getting things done, feeling awful and that's what I'm trying to get out of. I'm trying not to be overly negative and can recognise all-or-nothing thinking but genuinely can't see the point in this exercise and it's just made me feel like more of a failure than usual.

Is it ok to tell the therapist that this suggestion just doesn't work for me right now? Perhaps it's the technique that's wrong for me rather than me not doing it right? How ironic I'm having to use reasoning techniques learnt from CBT self-help to cope with a problem from CBT....!

Hi Anxiousmunchkin,

Definitely tell you therapist that it's not working for you. I have to say I am sceptical about all this cbt and mindfulness stuff...I am the type of mi d that needs cold hard facts...ie your anxiety is not going to make you go flipping crazy...fact is that ain't going to happen 😏

Be totally honest with therapist...they may be able to help on other ways.

I can also recommend a book called living with it...x x x

It sounds like the goals you have set yourself are just not achievable for you at the moment. A good therapist should be able to help you strip the goals back to what is truly realistic for you just now with half an eye on longer term goals too. Writing our lists and filling in activity diaries can just be totally soul destroying as you say, if all they become is a list of things you haven't done that taunts you. Definitely speak to the therapist and think of the smallest, tiniest step you can take (with her/his help) that will help you in the right direction.

Just waiting for my appointment, stomach churning but not too bad right now thanks to GP prescribing beta blockers last week. Feeling ok about telling her I just couldn't do this. I think.

Op in my opinion CBT should be used in conjunction with a talking therapy, you need to look at why your anxious and your triggers, this will probably mean more than 6 weeks. It requires a therapist who is more integrated and not just handing out worksheets.

If your not happy and it sounds like all this homework is adding to your stress then tell her so, there is nothing wrong wi practicing mindfulness, if it is part of a package of strategies.

I agree with you Guilty. Does the NHS offer them in conjunction? My experience is it's one or the other and have had talking therapy described as 'old fashioned'. NHS seems gung-ho for cbt despite evidence base being increasingly unsound . Hope it goes OK for you today Anxious, you are perfectly entitled to let the therapist know you're struggling .

Problems arise when the therapist is only trained in CBT and is very much out of their depth when asked a question outside of that training.

I'm not sure I know how I feel about it all at the moment.

My 'score' on the quiz thing at the start of the session had gone up quite a bit. She seemed concerned but I wasn't able to explain when she asked about any different triggers. I said I didn't really get the whole thing and we looked at my planner, she said I'd planned too much but even after talking about it I really can't see that I had. And I still can't get my head around the logic of just writing down less on the plan and then patting myself on the back when that's done, even though I know there's a ton more stuff needing doing it just didn't get written down.
Anyway I'm going away for a week so normal life is out the window, so im going to try the planner thing for the week I get back.

The therapist is a Psychological Wellbeing Practitioner, seeing her through NHS IAPT. I was impressed waiting time was less than a month when I self-referred. I'm a bit confused - CBT is a talking therapy isn't it? What else would you be recommended alongside? I self-referred as I don't want to go on antidepressants again after previous very bad experiences. Although I have spoken to the GP now and got the beta blocker.

They did say they also do longer 'high intensity' therapy but they recommended the 6-wk CBT for me after a telephone assessment. I don't know what happens at the end if I'm not getting better. They do a quiz thing to score how you're feeling each week, I guess that's how they gauge success or otherwise. My GP said that if I felt talking therapy alone wasn't helping and they thought medication might be appropriate they would refer to a psychiatrist. I just want to get better :(

My understanding of talking therapy is that it is more psychoanalysis - so talking through things in your past which may have contributed to your current state of mind. CBT is focusing on the here and now. Have you had any counselling or similar in the past?

CBT didn't help me at all. It made things worse by trying to get me to attribute blame for some of my problems on my parents. My parents are not an issue for me but I did feel temporarily angry at them because of the CBT which just added to my problems, not lessened them!

I also thought that some of the activities were well meaning but pointless. Writing a letter to an abuser then burning it to symbolise getting rid of my anger and hurt at him did not work in any shape or form and just caused me distress whilst writing the letter!

It does work for some, but for me it was no good at all.

Replacing negative feelings with lovely happy thoughts was something I was unable to achieve.