Session 8&9:

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Staff member
Jun 12, 2018

stuff we talked about:
-thought records
-what is exposure therapy?

We mostly talked about our thought records and gave our personal examples. We started talking about exposure therapy.
so basically the reason why CBT is so effective for anxiety and other related mood disorders and the reason why people... dislike it (because it's a bit rough), is exposure therapy - which, in simple terms, means facing your fears head on. exposing yourself to the situations you are most afraid of. classic example is someone with a fear of public speaking being asked to perform a speech, over and over, until the act no longer terrifies them

exposure therapy is meant to be consistent and repetitive, meaning one or two exposures will not help you get rid of the anxiety. you need to do it several times a week
and key point, ALWAYS START SMALL!!! dont start by exposing yourself to a situation that will give you 90% anxiety. start off with something that gives you 20% anxiety and work your way up

Questions to guide you after an exposure:
1. what i was scared of
2. what could go wrong
3. how realistic i thought this outcome was
4. (after the thing/event happens) look back and reflect

Lovely CBT resource shared by one of our participants!!


stuff we talked about:
- thought records
- exposure therapy continued
- hierarchy of feared situations

- manifestations of intolerance of uncertainty

Thought record completion walkthrough:
moods: these are something you rate percentage wise. if a situation made you feel anxious, you might say it made you 30% anxious, 60% anxious or 100% anxious. same with moods like depression, defeated, fearful, lonely, frustrated, etc

1. SITUATION - this is the where/who/what/when/why. which situation were you in PHYSICALLY when you started experiencing a rise in anxiety? describe it.

2. MOODS: this would be whatever you're feeling 0-100. sadness, anger, anxiety, fear, depression, etc.

3. AUTOMATIC THOUGHTS: these are all of the SUDDEN thoughts that pop into your head. some examples are: "i'm not good enough" "i'm a failure" "what if they leave me" "no one loves me" "they're just making fun of me" "why did i even try"

4 & 5: EVIDENCE FOR/AGAINST: this is the crucial step for these thought records to be useful to throwing away those troublesome thoughts. you are going to choose ONE thought from #3 that is the most dominant : "i'm a failure" and you are going to look for evidence that supports it, and evidence that does not support it. for example: "i'm a failure because i had difficulty in school growing up" VS "i'm not a failure because i got awarded a scholarship last year, I'm not a failure because i helped my friend today, i'm not a failure because i contribute good ideas to the world"

6. BALANCED thoughts: this is where you evaluate your evidence. most of the time, you will find that your automatic thought is untrue. so how can we change it? "i am a failure" becomes "i cannot always succeed" "i will make mistakes and that is okay" etc

7. RATE MOODS NOW: do you feel any calmer after having looked at your evidence? your moods might have had a drop in percentage. we are not looking to turn it into 0%, but to reduce it as much as we can.

CONTINUATION to exposure therapy:

so for those who are new to CBT and exposure therapy in general, it's the sort of thing that can really benefit people who suffer with anxiety disorders or phobias. basically, you identify everything that gives you anxiety that you tend to avoid, and then, dun dun dun, you ... immerse yourself in it

why this is helpful is because, at first it will be horrible and scary, but after you repeat it several times consistently, it will feel more like...ehh.... okay...that's not so bad
so for example somebody with a fear of dogs might start by looking up pictures of dogs on the internet. then they might listen to the sound of dogs barking. then they might watch videos of dogs. then they might watch dogs in an enclosed space. and then they might confront an actual dog

sometimes this is easier to do, other times it is difficult. this is why it's useful to create a hierarchy of feared situations, from things that don't give you that much anxiety to things that make you go "that's too much".

exposures pre-treatment are different from exposures during treatment. the latter is planned and organized by you, so that it is carried out over a specific duration of time. they are predictable and controllable. it is your decision to put yourself in that situation. they are prolonged so that you can get used to the anxiety and have it come down on it's own. they are frequent and consistent and you do not avoid them as you might avoid something uncomfortable that's unplanned. while the exposure is happening, we are asking ourselves the right questions in order to counter our anxious thoughts. like "is this so bad?" "what's the worst that could happen - i could live with that" "are your worst fears coming true? what can you do to cope?" etc
basically it's like a simulation that you place yourself in

saying this, i do understand that exposure therapy will not be effective for everybody

i am throwing this out there because it is generally practiced in CBT

1. avoiding doing certain things
2. finding imaginary obstacles and reasons not to do certain things
3. procrastinating
4. wanting to do everything by yourself, not delegating tasks to anyone else
5. only partially committing yourself to a relationship, job or project
6. looking for a lot of information before proceeding to do something
7. questioning decisions we've already made bc we dont know if its the best decision
8. looking for reassurance
9. reassuring urself with exaggerated optimism, or by always trying to explain everything rationally
10. double checking things by redoing them
11. over protecting others

intolerance of uncertainty -> we focus on all the bad things that could happen -> worrying about those things happening bc there is no guarantee that they wont
so...what do we do when this happens? do we attempt to change our environment, or the way we react to these things? the answer is quite obvious, even though we may not like it. the truth is, we cant control everything around us, so we have to control our own reactions.

"if I were tolerant of uncertainty, what would I do in this situation?"

obviously in real life we can't control what we face and not face
so i often go into situations unprepared and end up hella anxious in those situations. so when that happens, it's good to have a box or a little bag with coping skills or distraction tools
but when it comes to working on accepting uncertainty, we have to start with small things. leaving your house 5 minutes later than you normally would for an appointment. not brushing your hair before you leave the house. not charging your phone all the way before leaving the house.

try to confront ONE thing you've been avoiding doing lately!

-Alex :)