CBT (cognitive behavioural therapy)

I had to approach it with an open mind and I'm glad I did. It also filtered through into other parts of my life, not just anxiety. I learned how better to tolerate uncertainty. You can't eliminate anxiety from life, that's not how life works but you can learn to manage it. All the best with it. 

CBT for anxiety works to a degree for me but at times I just cannot get away on my own to unwind. I also did CBT for depression. A lot of these techniques expect for you to have a lot of time to unwind but if that was the case, I probably wouldn’t need so much help. 

Unknown said:

One to one adapted therapy for GAD worked really well and I am less anxious overall but it's not addressed anything autism related really. 

That's really useful to know - I'm about to start some sessions which hopefully will be suited for this as my consolation highlighted a strong possibility of GAD.  

My experience was the same as yours Dawn.

I am doing some more CBT this time it's an online system with message support in the form of fortnightly reviews.  It feels like a one system fits all. I feel I am going through the motions. It's not helping with the things I wanted to address and seems far too simplistic ("cut out caffeine. ...you are not your thoughts"...no *** Sherlock but how does that help me switch off?!). I honestly think if I didn't know I was autistic this would be doing more harm than good like it did a few years ago. I am more aware of myself now but if that wasn't the case, I would be made to feel like I am not trying hard enough and if I do it'd just fall into place.  One of the modules told me to face my fears WHICH I HAVE PROBABLY DONE ON A DAILY BASIS ALL MY LIFE. I never shy away from anything and that's probably because up until last year I didn't know I was on the spectrum so I just ploughed through thinking it was like this for everyone. 

I find the questionnaires difficult. I find identifying my emotions other than "ok or rubbish" difficult.  

I have been given this treatment off the back of asking for help with more autism related issues (eg help with daily stress) but they just went "oh it's anxiety" and set me up on this online portal. I know funds are stretched. I know there's massive demand even more so during a pandemic. It makes me really angry that autistic people are not able to access what they need because there's still such a LACK OF UNDERSTANDING and made to feel like they "just need to try harder". I can advocate quite well for myself but others can't and others don't even know they are autistic. If I had the time, energy and inclination I would retrain as an autistic counsellor.

I am aware that this contradicts my earlier posts and goes to show it really does depend on which service you use and who you get to speak to. One to one adapted therapy for GAD worked really well and I am less anxious overall but it's not addressed anything autism related really. 

I just think I am better off helping myself and continuing with meditation and mindfulness will be more beneficial.

So it’s been a few weeks now of CBT and I’m still confused and lost, the only thing I’ve got out of it so far is “thoughts are not facts it’s thoughts there not real” she does give me time to take everything in for a few minutes after she’s spoken to me but I’m sat there like I’ve no idea, maybe I have some kind of ADHD, I’ve been given thought diary which I try and fill out but makes no sense as she never looks at them  

I’ve out and out told my councellor half of the stuff doesn’t work for me. Thinking time and reaching out and sharing and the question about have you felt so bad you have no social life are inapplicable to me

hey thanks so much for your comment. you've made me feel less alone. i had a therapist like this for 15 months & it was extremely harmful. i didn't know i was autistic & by the end, he had realised i was ND & said that he's "had to accept it" which made me soujd as though i was difficult.

i think it really depends on the therapist. in my personal opinion, it is rarely about the approach but about the therapist themself. for 15 months i had a therapist (1 year telephone, 3 months face to face). it was a mix of CBT and ACT and was all labelled counselling. it was helpful in someways but the therapist would make me feel awful about myself at points because he didn't understand me- he apologised in the end. he helped me in terms of suicidality but in terms of interacting with others ie my autism, was quite harmful and i wish we didn't work on interpersonal relationships as much because the further we got, he became quite critical and i began to close off. i'm currently 3 weeks into CBT with an amazing therapist who is also looking into my autism. CBT should be adapted to autism however or it can be distressing otherwise. i hope this makes sense..idk if it does. 

CBT - youre not going to improve. But at least you know you better. Why are you not happy that you are doomed?

I had CBT at the age of 18. It was a complete waste of time and I thought the medical experts only recommended it because it seemed a fashionable miraculous discovery. Basically CBT is an excuse for a hands-off approach. They dont have to offer any help or interventions. You're going to cure yourself! Hallelujah

I had all this guff last year. I kept forgetting to fill the weekly stuff and always struggled with the social section as I struggle even when happy. I actually found the homework too stressful and so called “thinking time” more traumatic than just imagining. I’ve replaced thinking time with imagination time now

Interesting.  I guess there are ways to work around alexithymia if  everyone's aware expressing emotions can be difficult. Glad you were lucky (sorry for my earlier typo :).  How do we learn words and concepts for emotions?  Lisa Feldman Barrett says ideas about emotions vary between societies; they are learned. Maybe we didn't all get the opportunity to learn them.  I've read psychologists claim that you learn to recognise emotions in others, eg an angry adult, before you recognise them in yourself, but can't find a good source for that now. www.psychologyinaction.org/.../early-emotion-understanding-when-do-babies-learn-about-emotions

I have a kind of general negative feeling, partly physical and at worst like heartbreak in the chest, stronger at some times than others partly relating to self-concept, but usually describe it as depression rather than anxiety.  Might also describe it best with swearing...

A CPN gave me something like that once.  She just left it with me to fill out.  It had four boxes with sentences starting "I think", "I feel" etc.  About what? It looked like it was a vocab exercise for 6 year olds. In desperation I wrote a six page letter detailing ALL my thoughts and feelings about the situation in as much detail as I possibly could, in the hope that whatever it was she was looking for would be covered.

I was a bit puzzled by the whole thing, hadn't I been telling her all this anyway.  I think I was in the 'naughty box' again for having approached the exercise like that and no one explained how it was supposed to help or referred to it ever again.

'Course no one knew I was autistic then; but again you'd think the reaction to imprecision and level of details might have been a clue for them.

Hello Cassandro,  I only recently came across the word Alexithymia very recently. I looked into it, and I do identify with it.

Regarding my therapist, I just asked him to explain what certain emotions felt like for me, so I could see if my body identified with it. He was willing to find the best way to work with me, for the best outcome. I was lucky.

On a side note, my whole life I’ve been describing how I feel as ‘horrible’. Ie. My stomach feels horrible, people make me feel horrible, my chest feels horrible… the feeling in my chest was anxiety  I just don’t know how to explain anything properly.

That sounds like pretty standard CBT, trying to record situation, feelings and thoughts at particular times, maybe four or five times a week, particularly after being distressed or having a panic attack.  Then you can see how the thoughts and feelings and so on link together, and maybe clarify what you might be able to deal better with the depression or anxiety or difficult situation.  That's the theory.

It may be that the therapist hasn't explained very well what they want you to do.  Could they give you more examples or help you fill it in?  Have you read any books about CBT?  'Feeling Good Handbook' by David Burns, and the 'Overcoming Depression' by Paul Gilbert are often recommended.

Is it a question of knowing what is relevant?  Or is it particularly the emotions, sensations or images that are difficult?

Autistic individuals perceive and understand the world different. 

Thought might be primary, situation might be a behaviour (going through a motion but head somewhere else). Tied to that might be assumed behaviours or a trial of behaviours to try to mimic others. followed by more thought. Many times the emotion for all of this can happen 2 weeks to 2 years later. so:

THOUGHT / IMAGES (not a 'then' symbol, but one that implies a random event) SITUATION+BEHAVIOUR. THOUGHT. [very long pause] EMOTION? 

Can you identify your emotions and describe them? Has anyone ever asked why you perform or say a thing and what it is supposed to mean? If neither of these two have been sorted CBT won't work as it assumes a different ordering of thoughts/actions/being. A Neurotypical one, which doesn't work the same (thus why ABA is traumatising and never helpful).

I can't fill out surveys unless I'm given half a day to have a proper think and even then it's difficult if I don't have a pool of knowledge on each question. 

I’ve been given these sheets to do called “thought diary” and underneath in boxes along the page are -

SITUATION. EMOTIONS/MOODS. PHYSICAL SENSATIONS. THOUGHTS/ IMAGE ABOUT SELF. THOUGHTS/ IMAGE ABOUT OTHER PEOPLES EVALUATIONS OF MYSELF 

The other page has in boxes 

SITUATION  >  THOUGHTS/IMAGES >
BEHAVIOURS>            PHYSICAL SENSATIONS >EMOTIONS 

That would be good if mental health professionals knew about such things, and had a better understanding of autism in general that they could convey to their patients.  There are projects seeking to adapt CBT to autistic people that may take into account alexithymia.

I am mostly aware of using words and concepts that aren't in everyday currency and get various reactions when hoping to discuss an opinion or aspect of treatment: 'just because it's a word in psychology doesn't mean I as a therapist have heard of it', but then sometimes a psychiatrist has taken offence by me explaining what I mean by a word like 'epiphenomenal' as if I intended to 'talk down' to them.  You can't win.

Psychiatrists in particular need more training from people from the autistic community.

ive just started CBT, only had one or two sessions so far but have found it helpful so far