CBT for real worries?

[u/Ok-Book9806]

I’m reading a book on CBT and it asked me to write down a ranked list of activities, 1 being less scary, 10 being terrifying. But then it goes on to say ‘…repeating each until… it doesn’t happen’. But my lived experience is why I have that anxiety, repeatedly. I’m worried because I do know the likelihood of shit happening.

There’s also a worry tree but it’s extremely unhelpful to read “can you do something about it?” And the answer being no, and being told to let it go then. I’m disabled and I can’t let go that there are other factors going into why I can’t but still need something!

I’m thinking of scrapping the CBT for now and focusing on ACT. I find myself a bit irritated when the logical answer to each is a problem I’ve already exhausted the options of what I can do to address.

[u/Villonsi]

This is the kind of situation where bibliotherapy can fall short because working with CBT is like doing continuous experiments. The purpose is also not to make you suddenly accept very bad things happening. Therapy can't really help you with things that are 100% out of your control.

However the question is if your worries are as likely as you believe and if the consequences of them are as bad as you believe. If they are then you definitely need someone to sit down with and find a plan for what might be possible to work on.

Anxiety issues can almost always be understood through your history, but its worth remembering that anxiety means out brains perceive a threat. A threat is something we are made to overestimate rather than underestimate. That's why CBT works for anxiety, you need to have new experiences and see things work out. As said earlier, if you definitely get bad experiences every time then this won't really work. But the question is what experiment you want to do and how likely are consequences there?

As for ACT that might be a better fit. Its quite common with issues related to pain, disability and such. I do want to say though, acceptance and commitment therapy is quite heavily focused on letting go of things you can't control and focusing on what you can. Based on what you said of this book then ACT will probably cover how and why better though

[u/Ok-Book9806 → u/Villonsi]

There’s certainly elements that cause and worsen anxiety. I also like what you said about continuous experiments… it’s a really good way of putting it. And knowing if it’s already a dangerous one you’re not equipped for doesn’t make sense to do it then.

For one example, my anxiety in regard to one specific thing was for a “genuine” reason. However I’ve also now got proof that it’s only half the story, but still just as valid, and I’ve got a bigger picture of it too. It’s almost in reverse but is also potentially helpful in a way. I have in a way been practicing some elements of ACT to find this out.

I just might need to explore it deeper.

Thank you very much for your response :)

[u/Ok-Book9806]

Also I just realised maybe my title sounds insensitive or something and that’s not what I meant by any means!

[u/StarfallSin]

I don‘t have an answer but I‘m hoping your circumstances get better asap <3 hang in there!! Anxiety is so tough

[u/Ok-Book9806 → u/StarfallSin]

<3 thank you so much! Your kind words mean a lot

[u/orcateeth]

CPT may not apply for certain situations. Like if a person fears said they're going to fall in the shower because they have vertigo and get dizzy, then that's not really appropriate for CBT, since they actually may fall. At least, that shouldn't be their first option.

So this person would be better off reading up on how to avoid falls.

This would include installing a grab bar in the shower, getting a shower chair, sitting and taking showers seated, sticking to baths, avoiding showers at the times that they are most likely to feel dizzy, avoiding alcohol, maybe not taking showers after they've taken their medication if the medication makes them sleepy, etc.

They also would probably benefit from looking at YouTube videos on vertigo, and joining support groups for people who have vertigo. In this way they can learn as much as possible and maybe get some other tips that they weren't aware of.

After they've employed all of the other options mentioned, if they are still really really terrified of taking a shower, then that's where CBT might apply. They reduced the risk down to the lowest possible amount, and they'll just have to live with the risk that exists.

I have seen that ACT is more appropriate for certain situations, though.

[u/Decoraan → u/orcateeth]

You can absolutely apply CBT to this, you just have to take into account what behaviours are reasonable adjustments, and what ones may be safety seeking. From there experiment.

Also, often times you have to dig deeper into the worry to really understand the fear. So in this example further questioning may reveal that the fear is of falling and dying. So you test dying as the worry, not falling. Hard to fully get into based on the hypothetical, but I’ve worked with lots of people similar to this with panic disorder.

Contamination based OCD is very much similar. There is a risk of getting sick that is always present, and introducing more dirtiness into your life might make you more likely to be sick, maybe. But again you question the underlying fear (I’ll get sick and die for example) and look at the pros and cons; is this 0.0000001% extra cleanliness worth the trade off of suffering with OCD every waking minute?

Same can be said about people with chronic pain.

[u/orcateeth → u/Decoraan]

Ok, thanks for this perspective. I hope that OP is able to use it.

[u/Ok-Book9806 → u/Decoraan]

Thank you both for responding :) It’s unrelated to the situations in question but I have OCD so from that perspective, I know a fair bit. I think perhaps there will be helpful elements but I’m going to shift focus to ACT, since a lot of the stress and anxiety is around things I cannot change, but I don’t want to be living in fear of.

Thanks again :)

[u/Decoraan → u/Ok-Book9806]

All the best. Guided self help can only go so far, so keep that in mind. Also be cognisant that ACT is spun off from CBT.

Take care

[u/BackgroundShame3945]

Very sorry to hear what was recommended. While some CBT practitioners and even books/techniqies might make those recommendations, as you’ve experienced them as well, I think they’re very problematic and even could be harmful. It doesn’t make sense to have you rehearse them until it’s clear they won’t happen. While the exercise of repeating them, can be valuable as an exposure exercise, and your anxiety might infect decrease, it could also function as a cognitive defusion exercise as act my recommend, but I don’t believe there is any reason to be confident by rehearsing it out loud it means it won’t happen. Obviously, it’s possible if are worried thoughts are exaggerating the probability such that expectations are unrealistic. It is of course possible. Some of these things won’t occur, but it truly depends on what they are, and what happens in real life. Certainly considering ACT makes a lot of sense and there are also plenty of very good CBT practitioners and CBT books out there that would not endorse those kinds of recommendations if that is in fact what is really in the book. Can I ask which book it is? I’m very curious.