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Discussion Starter · #23 ·
Hmm now I'm confused. Aren't you arguing CBT is a waste? Exposure therapy involves just that - exposure, therefore this rules out challenging irrational thoughts (because apparently this is useless)...However above you are saying that we do need to challenge irrational thoughts with new behaviour...well that's cbt! - cognitive behavioural therapy. I think there is some blurring between how you are defining cbt and exposure therapy. Please clarify!
Now I'm annoyed with this because I felt you didn't read clearly my last post. I admit, my op wasn't clear enough and I wish I put more thought in my choice of words. But what really annoys me is that I suspect that even if your misinterpretation is true, you would judge me as being stupid or a retard just by making some errors. I hope this isn't the case that you aren't being overly-critical with me.

Anyway let me clarify. First of all, it is true that originally Exposure Therapy was thought to be effective because of habituation. This means that you face something you fear repeatedly until the fear goes away. However, I believe Exposure Therapy has been effective with those SAers who've seen a therapist specialized in that technique because they engage in certain behaviors that challenged their beliefs. Thoughts, emotions, and behavior are interconnected so that not only does thoughts influence our emotions and behavior, but behavior influence our emotions and thoughts.
 

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Discussion Starter · #24 ·
And two other sources isn't enough. What I mean is, a meta - analysis ; a gigantic study which pools other smaller studies comparing cbt and exposure alone (probably 50 to 60 studies) needs to be done before they can ascertain with any confidence that the exposure is better than cbt.
Actually, psychologists are very confident that the exposure therapy is essential for recovery. Cognitive therapy alone has been proven to being ineffective. In fact, let me site some sources:

In most cases, exposure is viewed as a necessary component of CBT. In fact, exposure may be even more powerful than cognitive therapy as a way of changing anxious negative thinking.
The Shyness and Social Anxiety Workbook by Antony, PhD and Swinson, MD

Behavioral disputing [behavioral experiments] is the most powerful way of challenging negative beliefs because we learn directly through our experiences.
Change Your Thinking by Sarah Edelman, PhD
 

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so basically, you have to change the automatic thought during the behavioral experiment, instead of in a nice closed off room with a therapist and you and the therapist are like:
"so we've identified the negative thought"
"yep, Ive now stopped thinking it"
"now if only you could stop it out there in a real situation"
"yep, that would be nice"
"yepperooo"
"yep indeedee"
"............."
".........."
"so....shouldnt we go out and try this in a real situation?"
"no, i dont leave this room...but at least your well trained to not be anxious when in this room"
"ok......but i dont live my life in this room"
"oh look at that! our times up, gimme my $160 bucks and get the *** out!"

so your better off doing your own cbt yourself during the behavioral experiment
I LOVE THIS!!! ESPECIALLY THE LAST LINE!!! :clap
There's a big difference between "the office" and "going out in the world."

I agree. It seems like both behavior & belief change has to happen together. If only one is focused on at a time, it seems to only give temporary change.
 

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Actually, I believe it is established that thoughts, emotions, and behavior are interconnected, meaning they both influence each other. So a change in behavior can influence your thoughts. Probably it didn't worked for you in the past because you weren't consciously challenging your beliefs and assumptions by doing a behavior that is inconsistent with them.

For instance, I believed it was very important how people were thinking of me. So, in the library I would look around the place constantly to check if anyone were looking weirdly or negatively at me. Then, I changed my behavior by not looking around so much, which was inconsistent with my original belief. After that, I became more comfortable, realizing that the thoughts of strangers about me probably isn't so important.
I like your library example. While reading it, I remembered a similar thing I did several yrs ago. Then I went on to finish reading the whole thread before responding here, and I couldn't believe it--MY EXAMPLE IS THE SAME ONE AS DR RICHARDS that you described later in this thread!

I used to avoid eye contact with people in the grocery store too. I would say "it's like I have blinders on"--you know, the kind horses wear. Then , spontaneously, (I really can't remember why), one day I just started looking at every other person I passed in the store. I could plainly see that not only were they not giving me dirty looks as they passed by me, most of them weren't even LOOKING at me! :)

It's similar to your library example in that I changed my behavior that normally accompanied my "paranoia", learned that I was wrong, and my feelings adjusted to the new information. Although this all happened quickly & spontaneously, it does show how behavior & beliefs are inter-related.
 

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ill giv u a litle insight and maybe it will help. this should probably be in the spirituality section but i think its relevant to your situation here so here goes :

before the physicall world existed all that existed was god and all the souls of humanity. god was GIVING his fulfillment to our souls and our souls were RECEIVING it.

all that existed was god, souls, giving and recieving, pure bliss, nothing else, no negativity , not even time, just endless fullfilment for our souls.
our souls had everything. we had it all. it was heven.

but then our souls sed ''STOP''. there is spiritual law called ''bread of shame'', its as concrete as gravity. bread of shame means that unless you earn something then its notyours and eventually you will feel bad about it. if someone kept giving you 100 dollars every day eventually you would feel bad and have to do something to earn it, thats a fact cos bread of shame is built into your souls dna. if you let go of a pen it will drop to the floor 100 times out of 100 cos of gravity, bread of shame is as concrete as gravity.

our souls were receiving allof this fullfillment but they hadnt earnt it so they sed to god ''stop. we will only accept this fullfillment if you give us a chance to earn it''

god was forcing this fullfilment on us and we were resisting it. at that moment the big bng happend and as a result the physical world, we live in 2day was created
bread of shame, souls dna, where did you get this information? I'm just curious. I'm not spiritual/superstitious but the bread of shame got me thinking about other emotions in terms of loaves of bread and I became throughly confused
 

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Discussion Starter · #28 ·
2 Depeche eyes.

First of all, I'm not judging you as stupid or retarded. That's probably your SA speaking not me. On the contrary I think you are one of the more intelligent people here because you take an interest therapeutic techniques for SA and the evidence base for them. 2nd, I don't mean to be rude but i think you keep misinterpreting that...why can't you just take other opinions on board instead of getting defensive?
Misinterpreting what?

I actually study psychology at uni. And I know what cbt / habituation / exposure etc is. And I know what kind of empirical research must be sought before one therapy is deemed better than another officially; a meta-analysis. Citing books as sources is not the best source of info, because it is far more likely to be coloured by the biases of the authors, to be based on only one study /no studies, or to be out of date.
I'm fully aware there isn't enough evidence that cognitive disputing techniques are aren't quite effective. Still, I believe it is most likely that cognitive disputing techniques aren't necessary.
 

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Discussion Starter · #29 ·
To LaRibbon:

Alright let me be frank here. I'm irritated about your question about why I keep misinterpreting you. It irritates me because I interpret what you said that I should just act rational and realistic when I'm a fallible human being who like everyone else makes mistakes. You pretty much answered your own question on why I misinterpret you: I have SAD.

But it angers me because you seem to be saying that I absolutely shouldn't be making such a stupid mistake like misinterpreting when you are aware that people have automatic thoughts. So of course, many times I prefer to be honest with people on how I feel and my thoughts rather than falsely appearing calm and rational. Sorry but I prefer to be honest than to put a false front.

I don't think I said that my interpretations are absolutely true. I'm aware that I misinterpret others. As you know, you can simply say that my interpretation is false and that would be ok.
 

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im not a fan of meds. as soon as u stop taking them your thinking returns to it origionally anxious state
the root of the socially anxious persons thinking is the subconcious mind. if you want to alter thinking patterns then the place to do it is the subconcious mind. medication does not change things in the subconcious all it does is mask the problem

alsowhy stick chemicals in your system and live with all of these sde effects when its not necesary ?

at the nd of the day to overcome sa you need 2 things 1) a change in thnking 2) a change in behaviour

now wether changing behaviour automatically changes thinking is a debateable issue. if it does then obviously ther would be no need for cbt cos all oyu'd need to do is change behaviour to beat SA

from personal experience ive done some exposure without the thinking and it didnt work but everyone is different, im not saying it wouldnt work for someone else
I completely agree with you here. Actually, its not whether I agree with you or not that matters, because what you state is a true fact. You can take meds, feel good, and expose yourself to situations and feel like you've overcome the anxiety, but once you're off the meds your thinking is gonna still be the way it was before, even after being exposed to anxiety situations. I know this from personal experience. I took meds from October up until about 2 months ago. Meds helped and I felt great and could do many things more comfortably, such as give a speech or talk to family or be the center of attention. But then I graduated and my insurace ran out before I could land a job so no more meds for me. Now that I'm off meds, my thinking is back to the way it was and I still have SAD. Yes, I have taken CBT and made lots of progress against SAD, but it has been a long time since I last did and I have never fully completed it or taken it enough to where I can say I truly overcame the disorder. Meds were almost like a false hope for me, because I felt I had made more progress against my disorder than I really had. I don't know how long it will take to overcome or how many days, months or years in a row I will have to keep doing therapy, but CBT is the only proven way to truly overcome the disorder. Meds help temporarily, but they DO NOT CURE. Sure you can take meds your whole life, but don't kid yourself and say you have overcome SAD just because you're on meds, cuz right when you get off the meds you will be back to normal in a flash. Theres nothing wrong with meds in my opinion, and I am not against using them, but just keep in mind that you never know what will happen, and one day you might not be able to get your meds for some reason. So best bet is to do therapy and TRULY be free of the disorder, even though it will take lots of time, patience, and work. Just my 2 cents.

And just for the record, CBT means BOTH cognitive therapy (thinking) and behavioral therapy (acting). You need BOTH OF THESE to overcome SAD. Not one or the other, and neither one is better than the other. You need BOTH together, because one of them alone will not do the trick. Thats why its called Cognitive-Behavioral Therapy. Because it includes both.
 

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Discussion Starter · #31 ·
And just for the record, CBT means BOTH cognitive therapy (thinking) and behavioral therapy (acting). You need BOTH OF THESE to overcome SAD. Not one or the other, and neither one is better than the other. You need BOTH together, because one of them alone will not do the trick. Thats why its called Cognitive-Behavioral Therapy. Because it includes both.
Ugh, let me say this again. I am not against Cognitive Therapy. I am against Cognitive Disputing Techniques. Behavioral Experiments are far more powerful than Cognitive Disputing Techniques.
 

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Ugh, let me say this again. I am not against Cognitive Therapy. I am against Cognitive Disputing Techniques.
I wasn't referring to you at all or going against what you were saying. Just stating that you do need both Cognitive and Behavioral to overcome SAD. That's not my opinion, its actually proven fact.

Just to back this up, or to help clarify why only behavioral doesn't work, is because if you don't fix your thoughts, and try to overcome on exposure alone, you will have a sense of failure when you expose yourself. You can put yourself in a situation you're not ready for as many times as you want, and your thoughts will still be the same. Once you get anxious and scared, you will feel like you failed, your thoughts will continue to run with negative thinking, and it will in turn make your anxiety worse.

If exposure alone worked that would be great, but that just isn't how it works.
 

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Discussion Starter · #33 ·
I wasn't referring to you at all or going against what you were saying. Just stating that you do need both Cognitive and Behavioral to overcome SAD. That's not my opinion, its actually proven fact.

Just to back this up, or to help clarify why only behavioral doesn't work, is because if you don't fix your thoughts, and try to overcome on exposure alone, you will have a sense of failure when you expose yourself. You can put yourself in a situation you're not ready for as many times as you want, and your thoughts will still be the same. Once you get anxious and scared, you will feel like you failed, your thoughts will continue to run with negative thinking, and it will in turn make your anxiety worse.

If exposure alone worked that would be great, but that just isn't how it works.
The problem is that you are forgetting is that thoughts, emotions and behavior are interconnected. Changes in behavior will change thoughts. The reason why your exposures may not have worked is because you probably didn't tested out your beliefs consciously through testing out a new behavior.

I've already given plenty of examples of behavioral experiments so you might want to read my earlier posts in this thread.
 

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The problem that you are forgetting is that thoughts, emotions and behavior are interconnected. Changes in behavior will change thoughts. The reason why your exposures may not have worked is because you probably didn't tested out your beliefs consciously through testing out a new behavior.

I've already given plenty of examples of behavioral experiments so you might want to read my earlier posts in this thread.
I totally understand what you are getting at. Changes in behavior can change thoughts, but only so much. In my experience, being on meds helped me expose myself to many things, and it was a change in behavior while I was on the meds. It changed my thoughts for the time being but I don't think it permanently changed any thoughts. I don't know what you mean by "testing out my beliefs consciously through testing out a new behavior." How do you do that? Changing your beliefs from negative to rational is a huge part of Cognitive therapy. Which again I believe this is needed before jumping into any behavioral therapy or exposure or whatever you want to call it.

But if you believe exposure alone, with or without meds, can do the trick, more power to you and good luck. I just don't think it will do anything to permanently help you against SAD. But if it does thats great.
 

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Discussion Starter · #35 ·
How do you do that? Changing your beliefs from negative to rational is a huge part of Cognitive therapy. Which again I believe this is needed before jumping into any behavioral therapy or exposure or whatever you want to call it.
This is what is called a behavioral experiment, also known as behavioral dispute and experimental technique. Like I said, you might want to check my earlier posts in this thread to get information and good examples.
 

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ACT is much like how you say Behaviorial or Exposure is better than CT. Look into Acceptance and Commitment Therapy. This is where it says it is better than Cognitive alone because they know it only goes so far, disputing alone may not give emotional relief or touch the emotions.

If you got a smart demon you are dealing with, then yes, deal with it on a physical doing way in some kind of way. Because you could be arguing with a nasty thing that wins on some emotional level though you know it sounds wrong.
 

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Discussion Starter · #38 ·
ACT is much like how you say Behaviorial or Exposure is better than CT. Look into Acceptance and Commitment Therapy. This is where it says it is better than Cognitive alone because they know it only goes so far, disputing alone may not give emotional relief or touch the emotions.

If you got a smart demon you are dealing with, then yes, deal with it on a physical doing way in some kind of way. Because you could be arguing with a nasty thing that wins on some emotional level though you know it sounds wrong.
Oh yeah, I heard about it! It seems like a very good form of therapy actually and shows a lot of promise! Can you tell me what it is exactly?
 

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ACT is much like how you say Behaviorial or Exposure is better than CT. Look into Acceptance and Commitment Therapy. This is where it says it is better than Cognitive alone because they know it only goes so far, disputing alone may not give emotional relief or touch the emotions.

If you got a smart demon you are dealing with, then yes, deal with it on a physical doing way in some kind of way. Because you could be arguing with a nasty thing that wins on some emotional level though you know it sounds wrong.
From my research and experience, the way to change EMOTIONAL beliefs from negaitve to rational is through LOTS of repitition of cognitive techniques. You won't believe the things you are saying at first, but if you keep repeating the cognitive material to yourself over and over and over, eventually you will "emotionally" believe new rational thoughts in place of old negative thoughts, which is the ultimate goal of the cognitive aspect of therapy.
 

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Oh yeah, I heard about it! It seems like a very good form of therapy actually and shows a lot of promise! Can you tell me what it is exactly?
The Mindfulness and Acceptance Workbook for Anxiety. It talks about how you can't talk youself out of things always but to

Accept the situations with mindfulness

Choose a direction

Take action

and goes along those lines of thoughts with a lot of tangents. 260 plus pages

It is about taking action on what you value (values are discussed: values could be family members, working, doing chores, exercising and eating right) despite how you feel.

One of the tangents has a cartoon that sums up some of the book. on 19-23 pages

1st cartoon- happy person walking on path toward a sun that says my life next to it

2nd-the person stops because signs pop up in front of them in the path saying panic, nervous, heart racing, painful memory, negative thoughts, and a ! sign too.

3rd- the person stomps on the signs saying "Not again!"

4th-the person is trying to breathe, cope, dispute, distract, medicate

5th-the person runs away in the opposite direction, backwards and takes the signs with them, carrying them

6th-person stops puts signs down and puts head down. saying "
Why can't I be normal?" Is exhausted and tired.

7th-the person says wait enough is enough and turns back toward the road and sees the signs in front of him again as barriers again, and thinks, maybe these thoughts and feelings are not barriers at all but a part of me and maybe I can bring them along with me as I do what I care about. And take compassion and kindness to whatever shows up. Person is staring at the barriers

8th-person picks up the signs and takes them with him in one hand and in the other hand is carrying the signs growth, vitality, mindfulness. Gentleness and Values are in the air.

The book has techniques too but talks about doing things more rather than disputing. Is it about doing what matters to you. It has exercises and such but active-oriented more. It has a bunch of pages that talk about how CBT does not work. I think they both are needed however.

I have a lot of books on different subjects. Glad to find this book again. :)
 
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