Most helpful CBT techniques?

Hi all,

I'm having a bit of a blip after a pretty bad panic on Wednesday night.

I'd say it's down to a number of things, one of which was me having a lot of homework from CBT but just not managing to settle to it. And I had an appointment today (though he ended up cancelling) and was concerned I hadn't done enough and haven't improved enough.

Because it's through the public system, I've ended up with a trainee psychologist who is lovely, but clearly still learning. I feel we haven't really achieved much together (had about 6 sessions so far) and he has just dumped a whole heap of handouts on me and wanting me to do too many things at once, which overwhelmed me I think.

He's asked me to do a worry journal (ie set aside worry time), do a thought journal and label any time I have an unhelpful thought, breathing exercises, grounding exercises, time management, problem solving, make a hierarchy of avoidance things to start graded exposure, and also wants me to do these exercises where you bring on the feelings of panic and have to ride it out (spinning in a chair, staring at lights, deliberate hyperventilating). It's all a bit much at once and feels a bit chaotic.

So, I need to start SOMEWHERE with all this.

What have people found the technique they've had the most benefit from?

---------- Post added at 15:13 ---------- Previous post was at 15:12 ----------

I will add that he is leaving at the end of this month and has not given me any indication if I will carry on with someone else or we will be finished in a couple of weeks.

So, is it possible that rather than tailoring the therapy to the needs of the patient, the needs of the trainee to tick some module boxes mighty have come first? :whistles: That wouldn't be the first time I've seen that.

I would say he has fallen into a trap there, too much all at once. This is a bad strategy if the client may not be able to do it all and they will just end up feeling bad about it.

It's sounds like a scattergun approach to me. So, what exactly has he been doing with you for 6 sessions to now through a whole load of exercises at you that should be spread out over therapy?

Bringing on panic is a Behavioural Experiment. If ANY of those could cause a problem with a health condition you perhaps need to speak to your GP. The hyperventilating one is not for everyone.

There is no question to answer around whether you have improved enough, there is no answer to it so it's just applying more pressure. Seeing it as from now to recovery is unrealistic and adds pressure, it's about micro goals and moving forward.

We did a couple of introductory sessions and then I can't exactly remember what the next couple were. Lots of handouts about the biology of anxiety etc. He's done a lot more talking than me. It's a bit like being in a lecture.

Certainly seem like a scattergun approach last session. I wondered if he had to tick off a few things before he finished his placement so last session just dumped a lot of handouts on me.

A couple of sessions ago we did the 'interoceptive exposure' where you make yourself have the panic feelings. I didn't get through all of them. He was a bit pushy when I said I'd had enough as was feeling very dizzy and had to drive home.

He was very insistent that doing these was going to be a big help in facing my fears of all the physical anxiety symptoms. Showing that you can cope with them and also that you can control them (ie start them on purpose). And the only way it would work was for me to also do them at home. I barely managed this as I didn't feel safe on my own to make myself feel really dizzy etc and next time I saw him I felt I'd let him down. I actually felt this particular approach was a bit dangerous! Would be interested to know if anyone else has done this and had success.

Today has been rough (again). Not helped by having him cancel the appointment as one of my triggers for anxiety after my experience on SSRIs when I couldn't even be in the house on my own, let alone go out. That left me with nothing to do this afternoon but too much anxiety to figure out anything else.

I managed to pop out to the pet shop and get some dog food and now see hours and hours ahead of me looming til bedtime, where I already feel like I'll lie in bed feeling rubbish and freaking out.

I feel like I've gone so far backwards in just a couple of days. This sucks!

You need a time management plan for the time management plan with all this! :doh:

Breathing exercises and grounding exercises are useful so can you add in a session of each a day?

The ERP plan is a one off exercise so can be added in wherever you have a gap. I don't know what that time management plan is without knowing more.

The interoceptive exposure stuff can be a Behavioural Experiment which is something you do to show yourself that you can cope. Those tend to be isolated though. Did he want you doing these on a regular basis to keep proving to yourself that you can do it? If so, not a BE, more just exposure.

Do you have reoccurring worrying thoughts? If so, short cut this by writing down each one and giving it a key. Then when your thought pops up, just fill in that key character to save some time.

What do you do in the problem solving?

Worry time can be planned in and maybe it doesn't need to be daily? Maybe not at first? Also, perhaps it's less important than the breathing & grounding exercises which can help you with the anxiety quicker?

Those types of exposure exercises mean having a safe environment. That might mean having someone with you to gain some initial reassurance. You will also need to make sure you can't fall or bang into anything so lots of soft furnishings are needed.

It's good you got out. You are still facing things as much as you can. The little things can feel like nothing when things are this bad but it's better than avoidance patterns and staying in more and having more time to focus on the symptoms as there is more chance of distraction outside.