CBT Not Working

[magpie253]

Hi,
I am about to have a breakdown. I have suffered from performance anxiety about work for the past 10 years. I have seen a number of therapists who do Cognitive Behavioral Therapy. I've tried all of their suggestions. I've been working with one CBT therapist in particular for the past year with spotty results. Lately, I have not been able to get my anxiety down to a manageable level. I have intense anxiety in the morning, and now I'm at the point where I just break down and cry every morning because I feel so hopeless. (Somehow, I make it to work and do my job.) I've also tried acupuncture, which has worked somewhat in the past, but now, does not seem to be helping. I also take Xanax, .25 mg. Any higher dose makes me drowsy. Is there any hope for me? Any suggestions? Sometimes I think I should not be working, but my husband insists that I work.

[Tessar]

Hello magpie. I am curious to know if your therapy has included working on your background... so things like childhood issues and the like? Although I had CBT, at the same time and with the guidance of my therapist I looked into my childhood and came to realise how much those experiences were still affecting me in the present. If I'd had CBT without the background work as well, I doubt very much if it would have worked for me. Speak soon, x

[robinsky]

Maybe your job is the cause of your anxiety? It is important you manage to get your anxiety levels down - there's lots of people who can help, not just CBT doctors.

I have had anxiety for several weeks and I know what you mean. Getting up for me and even putting my clothes on is an effort as my issues have really broken me down as a person.

Repeat after me: You are NOT hopeless. I think that your job, as already stated, might be a cause of your anxiety, or maybe you suffer from a lack of confidence? Maybe like me you need to build up your self-esteem?

Your husband, imo, should be more supportive - it sounds a dismissive attitude. All human life is valuable and there is hope for everyone and you are as important as anyone else, even if you think you're not.

As life goes on, so does your perspective become more significant.

[magpie253]

Thanks for your replies. Yes, I have been delving into my background/childhood, and I know experiences I had as a youngster, and young adult are definitely linked to my anxiety today. But my therapist has not really delved into how to use what I know now about root causes to deal with my current anxiety. As far work causing my anxiety, I know this is definitely the case due to low self-esteem, and I have been working to challenge my negative thoughts, but they are so ingrained, no amount of pep talking seems to help.

[Tessar]

Well, magpie, your situation sounds similar to mine. I always tried to work on through my difficulties though at one point, trying to do my job (I had a bullying boss) & do therapy at the same time became too much. I only had 2weeks off but it gave me a break. My intention was always to go back after the 2 week period and I did. Every day I took a nice walk. I just enjoyed being out in the fresh air. Also I kept my usual getting up time and you could say my "work" in that two weeks was a combination of some dull stuff like housework or food shopping, plus the exercise ... But also I did some clothes shopping ... New items to wear to work which gave me more confidence as I knew I looked better in new stuff.
When i went back, I'd hardly say my boss was supportive.... In fact he was often rude. So that made it hard but I wanted to get myself back on track and after a great deal of hard work, plenty of tears and frustration I did it. I became more self-confident and I learned to stand up to my bully boss and have not let people bully me since.
It's an ongoing thing for me even to this day. I am still learning about how I can be assertive. I am still learning how my past affected me into the present day. But importantly I am also realising I can be the person I want to be. Bit by bit I get stronger and fulfil ambitions. Sometimes it's just little things that make the difference. It doesn't have to be a huge achievement. Often we overlook the simple things that ultimately make so much difference in life. It's not all about the big stuff.
In the end, we do need to be given coping strategies. Suggestions that help us face the fears or worries. Also ideas that help us undermine our doubts. So tht we become more confident in ourselves. Sounds to me like u r more than capable of doing this but you need support.
First off are you able to ask your therapist directly for ideas? In my case I had thought records and so could report back as it were. Facing my fears generated alot of emotion and I couldn't have done it without the backing of my therapist bit in the end it was ME who did it. This is why I believe you can do it too, with some help.
Your husband is probably trying to keep you going and I understand where he is coming from but it's also necessary to feel supported and maybe his good intentions aren't coming across the right way.
Ultimately how you go about getting better is a discussion u can have with your therapist. Then once you work out a strategy, you can decide how to move forward. You can explain the overall plan to your husband and then he can support you through it.
I must be off to bed now (goodness knows I need my beauty sleep) but I have plenty more ideas and Suggestions because your situation is familiar to me & I can relate to where u r at. Of course I know we r all different but I am sure I can help you along the way.
Bye for now and I'm sure this is something u can get through in time.

[magpie253]

Tessar, I have never encountered anyone in a similar situation as me, so your words are comforting. Actually, I am lucky to have a very nice boss....but at one time I had a bully boss who berated me in front of co-workers, and I believe that triggered my anxiety ten years ago. Since then, I have had the anxiety. My fear is of making mistakes at work. My therapist has given me some tools to cope with my anxiety, but the anxiety continues. At one time, I thought I had it under control, but now it has shot up again. Sometimes, my anxiety is "free floating," not triggered by any negative thoughts about work. It just happens every morning as soon as I get out of bed. I use the therapist's CBT suggestions while I get ready for work, and I often open my office at work in anxiety mode. However, once I delve into work, the anxiety subsides, but I am completely drained by then. Sometimes, I just cry in my office because I'm so tired of living like this. So, that's where I am right now. I have been to about a dozen therapists since the 1990s, and I can't seem to find the help I need.

[MyNameIsTerry]

Focussing on something strongly prevents you listening to your unconscious mind and doesnt give your conscious mind the space it needs for anything else (just like RAM on a computer). I've done this but I've found that in the end, it starts to get worse away from work and then it intrudes on that work safe zone as well.

CBT isnt always successful. Mine wasnt enough for me but a fair amount of that was me not pushing through the obstacles. But is CBT going to be enough for you? Using techniques to reason out situations and challenge or accept thoughts is fine but to boost confidence & self esteem you need to prove to yourself that you are a capable person. So, it would useful to find ways to do this e.g. if someone is self conscious of their body, exercise to improve it can boost these. What could you do to boost this? Would this help?


I know this helps me because I feel more capable as a person.


It sounds like you dont trust yourself. Acceptance is something you probably need to work on, but its hard.


Have you tried Mindfulness meditation? Its a relaxation technique as well as a way to be in the moment and accept things. It helps you control your thoughts, break OCD style patterns and understand that sensations are nothing more than that.

[magpie253]

MyNameisTerry, thanks for your post! Yes, low self-esteem is a huge issue for me. I have a lot of difficulty accepting myself as I am, and what I see as failures in my past work life...I even switched careers, and it's like I'm still affected by past mistakes in a different career. I also have difficulty with mindfulness meditation, but I am still trying it. You are right, though, that I need to work hard on accepting myself, warts and all. What did you do to "feel more capable as a person?"

[MyNameIsTerry]

I think for me Magpie253, it's an ongoing theme.

I have found that being able to help people gives me a good boost, hence being on here. I used to attend a self help group and it does make you feel better, especially on your better days if you can help someone who is not as far along as yourself.

Right now it's more about exercise and looking towards goals that I want to achieve to make me feel better about myself. For instance, lose the weight I've piled on, get back into weight training and bulk up a bit, get fitter so I can tolerate the sensations more.

I think you have to find things that help you feel worthy. Worthlessness is a big issue once you've had anxiety for a while and it feeds the depression. If you can find things that improve your sense of self worth, I believe it will improve self confidence, self esteem and make you feel more capable because you are achieving more, even if they aren't big things. Until you are ready to make big leaps, anxiety is a matter of small steps and micro goals or you end up overwhelmed and depressed again.

Volunteering is one I want to do once I push on past the exercise. I see that as one step closer to going back to work and I can help others, even in small ways.

My last job was all corporate slog for little or know benefit. No one cared, I doubt they would have missed me half the time. In the last few weeks before I couldn't take the anxiety anymore, I was having quite long breaks due to panic building...no one ever asked anything. I was pretty much working for myself despite being in a structure and whilst we worked alone a lot on projects, you would think someone would notice when you aren't there!

So, for me, I need to tackle that issue and find something that will feed my self worth. Otherwise, I could just slip back down that slippery pole again into dread.

Can you think of things that would make you feel more valued?

[magpie253]

MyNameIsTerry, I appreciate your advice. I have had therapists tell me this too, and I have done things outside of work such as exercise and choral singing, which help. Funny thing, my boss, who is very kind and thoughtful, told me that he can't run the office without me; that I am indispensable. But I have a constant worry about making mistakes at work, and I wake up every morning with anxiety, sometimes pure panic.

My anxiety has its roots somewhere in my childhood and I am working with the therapist to attack old ways of thinking, and build my self esteem. But I also need to tackle my anxiety in, as you say, microsteps and with small goals.

Thanks.