CBT (cognitive behavioural therapy)

Cassandro said:

I have had to explain 'alexithymia', not knowing what you're feeling to several therapists. 

I find that worrying. Aren't they supposed to know and be the ones to explain it to us?

The thing is, I know when I'm ruminating, I know the thoughts are illogical, I can analyse the thoughts but it doesn't stop them. I know when it's black and white thinking but just identifying it as an unhelpful thought pattern doesn't help. 

There was an element, in parts, of "going through the motions" in CBT but it still was very useful.

Also, a lot of my physical feelings were not on the predetermined list for anxiety symptoms....maybe I was interpreting them differently but my explanations and feelings didn't match with typical anxiety symptoms. However, these intense anxiety symptoms have reduced to almost nothing now from the therapy I had.

I'll second that.  I went into it all willing and hoping to find solutions only to be dumped on the 'naughty step' for being unable to answer questions about what I feel in my body - I never realised other people have something related to their emotions to feel in their bodies, actually and anyway bodily sensations freak me out, or answer vague, open questions like "What are your thoughts?" - about what specifically??  Or because I wouldn't agree that my mother was abusive when I was telling them she had said I seemed to reject her as a tiny baby and wouldn't hug her (you'd think that one would be a red flag for autism) and because I was giving them too much detail - oh yeah, and did have full blown melt downs in there when pressurised to be aware of body sensations - also, you'd think, a red flag for autism.  It did feel like we were trying to speak two entirely different languages.

I can't blame them for not having understood, but I am blue blind furious that they actively blamed me for the failure of the therapy, rather than investigate why it didn't work.  No, therapy designed for NTs is limited or no use for us in my experience.  But that's not to say that no therapy will ever work, but it's got to be tailored to ND wiring.

Buz89 said:

becoming more difficult every time as I’m having to complete the questionnaires every time about mood, emotions, feelings

Do you know what is difficult about it?

I've found things don't fit in the boxes and get far too complicated.  And I don't think mood, emotions, feelings are very apparent even to me and may be different from what the therapist expects.  I have had to explain 'alexithymia', not knowing what you're feeling to several therapists.  Plus getting around to the forms or remembering to do them when distressed.

The basic ideas of CBT, Five Areas model and so on, makes sense to me, and reading CBT books wasn't time wasted. For example it can explain why ruminating is unhelpful and forcing yourself to do activities you should enjoy is worthwhile for energy and motivation.

I do think there should be CBT that is more flexible for autistic people, but there isn't in my area, and you just have to hope the therapist understands or ask for another one.

I had perhaps 12 sessions of CAT (cognitive analytic therapy) before my diagnosis.  I got the 'reformulation letter' and thought I'd not been understood at all, no progress and a waste if time. Basically any therapy with 'analytic' in its name is likely to be useless at real problem analysis.  Yes, again I tend to thoughts rather than feelings.

Other experiences may vary, so just my 2p's worth.

Yes, a lot comes down the therapist rather than the therapy, and also acknowledging our differences as patients.

I describe myself as 'alexithymic', meaning I don't know what I feel, which makes therapy difficult or irrelevant.  In all my years of therapy, I don't recall anyone explaining emotions to me, so you were kucky.

Any particular talking therapies?  I've heard CBT called a talking therapy.

I think counselling that involves a dialogue is indeed more likely to be comprehensible and useful.

Done CBT, don’t recommend, didn’t do me any good. Made me feel even worse.

I couldn’t understand them, they couldn’t understand me.

Once I was accused of not trying hard enough and of hiding something from my therapist because I couldn’t answer her questions. I just didn’t know the answers. 

Talking therapies were better. They didn’t help but at least didn’t make me feel worse. At least I could vent. Which was nice.

Oh certainly, I myself absolutely abhor the thought of that question, as right now im fighting my own GP for the right for me to have liquid format anti-depressants because i cannot take tablets.

People always ask me "how did you feel" or "how do you feel" but a lot of the time i cant even explain anything Buz89 - Just to key you in to prevent multi replies

I got lucky on my first round of anti biotics before i came of them and they said "if you feel better, then they are working and we should keep you on them" however now im just very unlucky and cant get back on them lol, they keep telling me no

What helps me is to write notes down so when I get to speak to the GP or anybody I have it right in front of me. 

I found it very hard. The first lot I had just didn’t cut it, but the second time round I had ‘intense’ CBT. The therapist was great. I had him ask me questions in a certain way, to simplify stuff, and to help me figure out my feelings and emotions. He described things for me, and suggested how my body may feel, in response to my situations so then I could identify with it. 
It was the first time in my life I realised I don’t even know what I feel, let alone now to describe it.

I think it helps when the therapist is aware of your strengths and weakness.

Personally I found that all the repeated prompts my CBT therapist used, as to getting me to think about all of the "whys" regarding the causes of my social anxiety and behaviour, was one of the things that nudged me towards looking towards considering Autism as the main root cause of most of my interpersonal issues and anxieties.

I found that  the only answer that completely fits, to the question of "why do I have social anxiety when XYZ happens" is "Because I am Autistic". I think it would be helpful to begin therapy all over again, but with being able to provide that answer from the outset, and  then asking the therapist "Now what?"

I didn't properly twig that I very seriously consider myself to be Autistic until my penultimate session, by which time it was too late to do anything else other than discuss my next steps for getting a diagnosis. I had raised the possibility many times previously that I though many of my issues were Autism related, but kept getting brushed off with "everybody is somewhere on the spectrum." To be fair, therapists aren't trained in Autism, although I bloody well think they should be, at least more trained in basic awareness of Autism!!

As others have said already on this thread, therapies specifically tailored for dealing with anxiety due to Autism could be much more beneficial than the 'off the shelf' untailored CBTs which didn't do much for me either. Ideally the therapy would be from someone who has Autism themselves, or someone who at least understands it properly, obviously is crucial. From what I have heard so far such a thing is very rare. If so, this is a diabolical state of affairs.

Dropping my safety behaviours and just being myself is just not going to work for me, in terms of reducing my anxiety. Understanding why other people react to me in the way they do, is already proving FAR more powerful. Not understanding the why behind all of my difficulties is what caused my anxiety in the first place.

There is a lot of good news since I have self diagnosed. Unfortunately though I have more than 30 years of social anxiety as a conditioned response, and it's not going to be easy to change that. Even with now finally being able to understand the why underlying the whole thing.

This is so important! There needs to be a whole new branch of therapy for this!  Or is it all just too niche, too unimportant, too few people struggling to get any attention, funding? I don't believe that it is. There needs to be more therapists trained in such a specialities.

Yeah I know what you mean. It's too vague. But if they asked me more specific questions it'd be easier. Then what usually happens is i think clearly what i should've said after ive left. Also I find it difficult to explain myself.

On a social level if a question is too vague I might say "in what sense?" Maybe I need to do this in more formal settings. 

This happens to me when I go for a medication review at the doctors and the GP or the pharmacist will ask how have you been doing on the medication and I’m trying explain how and I can’t explain it. 

I think it probably depends on what sort of therapist you get. I had a counselling session once where I was asked about an event "how did it make you feel?" that's too open a question! I didn't know how I felt at the time and I still don't! 

I have to say, I tried CBT, and found it rather distressing where they constantly ask "why", and if you don't know the answer, they still aks why you don't know and it gets infuriating, so I can attest to its irritance, as I stopped engaging and said to the counselor, "listen, I don't think CBT is working, please can I try talking therapies" and for me, talking to someone and having a dialogue is MUCH better than "why" every 5 seconds, also with Talking therapies, you explore why you feel the way you do without all the questioning, instead its more like a discussion with someone who cant judge you :D

I did group CBT and it made me worse (why should I belittle myself with saying my thoughts are irrational?! They are not! Everyone else is the problem!).

I had individual CBT with a very good therapist whom I told I thought I may be AS (and subsequently got diagnosed separately during my therapy by a different person). This CBT was more about learning to accept anxiety and seemed close to what my assessor said was more appropriate for autistic people - CAT or ACT. It addressed the general anxiety and was incredibly helpful for that, but I still struggle with anxiety which I think is more to do with being autistic. I too found the questionnaires difficult but tried my best. I found it difficult to talk about emotions, I tended to talk about my thoughts more as I think that's how I navigate emotions. There's nothing wrong with that.

Mindfulness I have found helpful and breathing meditation / exercises. It certainly doesn't stop the overthinking or anxiety but it does calm it down. Some people think it's a load of baloney but I say approach things with an open mind and see what works for you. 

Okay I didn’t know about ASD CBT I’ll ask at my next appointment 

Maybe ask for ASD adapted CBT? It often isn't a good fit for us and encourages us to change our behaviours and make us more 'NT'

Yep! and it doesn't work!

Apparently, it can be made to work better if adapted for people with ASD by someone who knows what they are doing.  But I had the common or garden variety.