Worsening social anxiety - CBT doesn't help. Don't know what to do.

[moofo]

I have suffered with social anxiety in the past but it's come back recently and seems to be getting worse and worse. It's not just being nervous before/during social interactions - it's mainly that afterwards I cannot stop obsessively replaying what happened and thinking I embarrassed myself or everyone hates me.

It's got to the point where every single (even brief) social interaction is causing me great anxiety. Examples:

• I've been recently trying to sell old baby things on Facebook marketplace. There are things I'd happily give away for free but often advertising for free seems to attract difficult/entitled people. So following an idea I saw on here, I advertised something for £5 and when the person arrived, told them they could have it for free. Unfortunately I think I seemed to offend her and she insisted on paying and seemed a bit put out. Afterwards I realised maybe it looked like I thought she was poor or making her into a charity case or something. I've also sold other things and found that every time I know someone is coming I'm so nervous and after the ten second interaction I have with them I worry that I looked weird or said something strange or that the item isn't good enough and they were disappointed.

• I've been going to various baby groups with my one year old. Last week I went to a new one and one of the ladies running it offered to show me their sensory room after the session. At the end she asked if I wanted her to show me out (or something like that) and I thought she was offering to show me the way back out to the exit (as I was new) so said 'no thanks'. I later realised she was offering to show me the sensory room on the way out and then I worried that I came off as really dismissive and literally couldn't stop thinking about it for the whole day. I also keep worrying that none of the other mums like me or that I seem weird. My son is very shy and scared of strangers and although he's improving as I have started to take him to more places, I know I'm the one to blame. I had a traumatic birth followed by months of colic/reflux , and so I became quite isolated for a while. When we arrive at groups, he is always scared and cries if people speak to him. I worry that the other mums will be judging me for it.

• I have very few friends but there is one couple that my husband and I have always got along well with, although we only see each other occasionally. Now that they have a child of their own, we have been hoping to get to know them more and see them more. While visiting recently, it became clear after a certain amount of time that it was time for us to go as they needed to sort nap time out, and so we left, but afterwards I realised perhaps we should have left 15 - 30 minutes earlier and we probably overstayed. I didn't pick up on this at the time but looking back there were hints I should have picked up on and didn't. I feel really embarrassed and angry at myself and convinced that they will hate us or at least be annoyed or be reluctant to see us again.

While I know that the only way my anxiety will improve it to continue socialising more often, and "facing my fear" the level of anxiety I feel any time I'm around anyone else is making me miserable and is making me feel I'm not worth it. At this point, only knowing that I need to do it for the sake of my son is keeping me going to all of these things. It's been at least a solid month of me really making an effort to do groups/socialising most days and my anxiety is not improving at all. In fact it may be getting worse.

In the past I've never had anxiety regarding those close to me but currently I do. I worry that my mum is sick of me or doesn't want me around. I worry that my husband is annoyed with me or distant. I get worried he will find someone else and leave me, which is not me a all. I've never been that way. I keep looking for reassurance which ironically is probably quite annoying.

While all of the negative thoughts I'm having would probably make me a prime candidate for CBT, I've tried a couple of times and have found it not only unhelpful but actually made things worse. I completely understand that negative thoughts affect my feelings and so I try to identify them and replace them. I practice this a lot but cannot get myself to actually believe the thoughts I am replacing them with. I say the thoughts in my head but my anxiety doesn't improve as I don't believe them. I try to identify cognitive distortions and challenge them, but it doesn't matter that I know I am "mind reading" - I still believe that I am mind reading correctly. I know it's not a helpful thought but I can't seem to logic myself out of it. When I have tried to explain this to my therapists and asked for advice, I have been told that CBT only works if I am willing to change and it is implied I am not trying hard enough. I desperately want it to work and although I'm clearly doing it "wrong", I can't seem to work out how to do it properly.

I've also tried paying for counselling privately and had person-centred counselling a few times. This has often helped in the short term and even perhaps has made some permanent positive changes in regards to coming to terms with things that happened in my childhood. However, on the whole I generally find that in the beginning, the validation and reassurance helps but this doesn't last long. After that I feel like I just talk myself in circles and don't really get anywhere. Doing this privately is so expensive and so eventually I just quit.

Maybe I am just not cut out for therapy or maybe I haven't found the right one. I don't know.

I will add that I was diagnosed many years ago with pure OCD. It's something that's always there but seems to wax and wane, sometimes affecting my life a lot and sometimes not at all.

The anxious thoughts I have after socialising feel very much the same as my intrusive OCD thoughts in the way that they're so relentless and I am unable to stop them. I was on antidepressants for many years and a happy side effect is that it somewhat lessened the intrusive thoughts so they were more manageable.

I am starting to wonder if my social anxiety would be helped by returning to antidepressants. However, I am currently on medication for ADHD. I sought diagnosis privately and I am on a shared care agreement with my GP. I am unsure if my GP would prescribe them while I am taking stimulants, and I am very reluctant to come off my ADHD medication as they've helped so much in other ways. It's something I'm definitely considering asking about, but I guess I hoped that I could do this without medication.

Thank you for anyone who has managed to read for this long. I guess I am just feeling quite down at the moment about everything.

Hey didn't want to read and run. I have ADHD and this sounds like me. You're doing better than I did I swayed all baby groups with both my kids so good on you for ploughing through despite how you're feeling! I actually have decided to stop being hard on myself now, if people think I'm odd or are sick of me I just think we'll they'd say so and also who cares really. A thought is just that, a thought. And even though they're intrusive we actually have the ability to take the power out of them. So perhaps next time you get these intrusive thoughts, try saying it in a weird cartoon character voice, or something along the lines which takes the nip out of them, once you do it a few times you can't actually be bothered to entertain them. Then you will gradually notice them become less and less and so forth. How much self care do you implement? You're worthy of self love and taking care of you and talking about yourself in a kind way. Have you ever considered EMDR? I think it can be pricey but its done me the world a good perhaps a different avenue to try? I really hope you find the help you need, you sound like a wonderful mum and I'm sure you're a great partner and daughter don't be so hard on yourself x

CBT is very very hard. It feels like your fears are being minimised or dismissed. You turn up thinking you’re going to chat to someone supportive but it doesn’t end up feeling like that at all.

But CBT is amazing. Incredible. Stick with it. It’s not an Instant miracle cure. Maybe change practitioner if that would be helpful, but don’t expect it to be anything other than really hard.

What does your psychiatrist say about the anxiety? Are you on Elvanse or similiar stimulant? Has it got worse or better since starting adhd meds?

This sounds similar to my situation.
When I first started stimulants I was on a low dose of fluoxetine so it should be possible to take both. If ADs have worked for you in the past, it’s definitely worth an ask.

Thank you for your replies. I am so touched you took the time to respond to my post and I am sorry I am just now getting back to you.

@CourtneyB123 Thank you for the encouraging words. I like the idea of saying the intrusive thoughts in a silly voice as maybe that would help to separate them and make them seem so serious. I will give this a try. I probably don't practice enough self care but I am going to try to do so more. Interestingly I have heard about EMDR and I have been intrigued by it although I have not looked into it properly. How many sessions did it take you to notice a difference? I could afford something like that privately as long as it wasn't too long term. If it is the kind of thing that takes a lot of sessions, I probably wouldn't be in the financial position to do it for another year or so.

@SprogTakesAQuarry Thank you for your reply. You're absolutely right and that's exactly how I've felt - kind of dismissed. I completely get that its not the "just here to listen" kind of therapy and that it takes work, but I guess I had still expected for a bit of empathy and validation, while also pushing me to challenge the thoughts at the same time.

When I do all the homework and spend a lot of time practising what they're telling me to do each day and nothing changes, I can only assume that either I'm doing it wrong or that it's not working for me. It makes me feel kind of stupid like I just don't seem to be understanding how to do it despite trying my best. I would not be completely opposed to trying again with a different practitioner.

I have not yet spoken to my psychiatrist about the anxiety because the last time I met him for my medication review my anxiety wasn't really bothering me, other than a general low level anxiety that I've always had. I could book another appointment with him to discuss but as it's a private practitioner that I've gone to specifically about ADHD, I wasn't sure whether I should go back to him or just to my GP. I am on Methylphenidate (extended release) and I haven't really noticed any change in my anxiety. I think maybe when I first went on it a couple of years ago there was initially an improvement but since then I've not noticed any difference. My anxiety has gotten worse lately but I haven't changed my meds in that time or anything.

@Walkingwalkingwalking Thank you! It's reassuring to hear that you have taken both in the past. I will look into this and ask about it.

Hey @moofo - no need to say sorry for not replying sooner. You have ADHD and anxiety. Well done for returning to the thread at all 😁

I think maybe try a different practitioner. The
exercises in CBT are like reps at the gym. You need to get them locked into your muscle memory. A good CBT therapist should be able to support you through that process and reassure you that you’re doing it right. It will take time, and it is boring. It also isn’t an instant fix in the moment. When you do those exercises, you’re doing them for future you. Present you may not get much relief. But in time, you’ll start to find yourself thinking slightly differently, then you’ll find that new way of thinking becomes more automatic. That’s when you’ll see the benefits.

I am on an SSRI and ADHD stimulant medication. It’s a good combo for me. My SSRI is to manage depression, but just to reassure you that the two work fine together.

Good luck!