CBT DIARIES | Session 4: Exposure Therapy Begins (aka DO NOT WANT)

This is post 4 of my journey sharing my experience of group therapy (cognitive-behavioural therapy, or CBT) for social anxiety. Check out previous posts below!

  • Session 1: recognizing the sensations, thoughts, and behaviours of anxiety
  • Session 2: introducing cognitive distortions
  • Session 3: countering cognitive distortions

And now Session 4: introducing exposure therapy (aka facing your fears). We’ve moved into the B (behavioural) part of the program.

I am, appropriately, scared shitless.

[Edited 07/12/18 to add] 

A special note for any former group members who may stumble upon this series…

Hi there 🙂 If you haven’t read any of the other posts, let me assure you that I have never revealed any personal or confidential information about you or even shared your stories anonymously. I may have made brief references here and there to “group members” as an anonymous whole, but never in specific or revealing detail. This series has been strictly and diligently focused on my own experience and thoughts. I truly hope that in writing it, I did not do anything to make you feel that I breached the trust of our group. Good luck to all of you and thank you so much for being so brave and supportive. xoxoxo

In a nutshell, the rationale behind exposure therapy is “short-term pain, long-term gain.” This is the opposite effect of avoidance, which provides short-term gain but long-term pain by reinforcing anxious thinking patterns.

It is (apparently, because I haven’t done it yet) like watching a scary movie over and over. The movie gets less scary the more you watch it, for a variety of reasons: you’ve watched it before, so you know what’s coming. You know you’ve gotten through it before. You start noticing things you didn’t notice when you were scared and hyperalert.

It also makes me think of what I was often told as a kid if I fell off a play structure, or as a teen if I had an anxiety-provoking experience (driving, for example). Get back up there/out there so that it doesn’t get built up in your mind.

Avoiding anxiety triggers gives them power. Facing them takes that power back.

(even though it will feel like absolute ass-clenching teeth-gritting vomit-stifling mortification in the moment, but I digress)

Our group leaders told us that our bodies can only sustain a high level of anxiety for so long until our parasympathetic system kicks in and brings down our anxiety naturally. If you flee the situation too soon, you’ll never get to that lower-anxiety place.

Basically, if you’re willing to have a standoff with your anxiety, it will eventually fall asleep, unlike the preschooler who tried to engage me in conversation all last night. He won that battle. But I can win the war on anxiety.

(Actually I don’t like to think of it in terms of being a war on anxiety — I think self-acceptance and self-compassion are healthier perspectives, but they didn’t fit the sentence as well.)

I’ll get into more specifics on exposure practice in my next post — today was really just introducing us to the concept and getting us to brainstorm potential practice scenarios. Here are a few ideas they gave us to get us thinking:

  • Make a telephone call (ew, don’t people know about texting?)
  • Read in front of others (by “read,” I assume they mean “stammer with face of tomato”)
  • Refuse an unreasonable request (I’m allowed to do that?)
  • Offer an opinion that is different from someone else (BAHAHAHAHAHA people don’t actually do that do they?)
  • Buy one Timbit from Tim Horton’s (WHAT DID I EVER TO DO YOU)
  • Ask for the time in a location where the clock is clearly visible (ARE YOU MESSING WITH ME NOW)
  • Buy, and five minutes later, return, the same book (I’m out, I’m done, this is too much)
  • Engage a stranger in conversation while trying to be as boring as possible (NO REALLY, I’LL KEEP MY ANXIETY THANK YOU)
  • Order something that is clearly not on the menu, like pizza at Tim Horton’s (silent implosion in progress)
  • Intentionally make a grammatical mistake online (I’m sorry, Sadie has left the building planet)

So… yeah. Umm… This is going to be hard.

Session 4 take-home messages:

  • I think I’m going to just stick with the short-term gain, long-term pain plan.
  • Maybe having social anxiety isn’t that bad.
  • I mean I can just max out my medication and say fuck the bedroom-numbing side effects, right? (Did I just go there? Yeah I did.)

ACTUAL take-home messages:

  • Stubborn resistance aside………. this will probably be good practice.
  • You can’t have courage without fear. (Gag.)
  • UGGGGGGHHHHHHHHHHH

What I’ve learned:

Sometimes… a thing is just hard. And you have to focus all your energy on just. showing. up. That’s all I’ve got right now and I’m clinging to it.

Virtual hugs (because despite my foot-stomping mood, I still super love you for reading this),

Sadie

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