Disclaimer: I did CBT 20 years ago at a research university that is/was known for CBT research, and this post had been sitting unfinished in drafts since 2016. A lot of stuff may have changed since then!
Another one of those comments I’m always leaving.
CBT is amazeballs. It’s also what they use in Bradley class for natural childbirth. It takes practice but it totally changed my life even more than just the test anxiety I was getting it for. I’m so much of a calmer person now. Every time I start getting anxious my deep breathing automatically starts up. Personally I think everybody should get trained in it starting in high school!
It also has the benefit that it’s a set of specific techniques and once you’ve learned them, or learned even a set of them, you can stop going to therapy* for the specific anxiety. The one I did was a 6 week program, IIRC. (They graduated me a little early because I responded really well to the early techniques, which makes sense as they teach the most effective ones first.) I went to a university program, which was nice, though I had to wait a few months before they could see me. A private practitioner might not be as systematic, but may have less of a wait. (DH tried it locally as a professor and it was not as focused or as good.)
The main idea behind CBT is that anxiety causes a physical response that makes you more anxious. If you can interrupt that physical response, you have a chance at letting your rational brain take over. Ditto negative repeated thoughts (what my therapist called “ticker tape”). It is NOT about getting to the root of your problems. It’s only about getting tools to treat the symptoms of anxiety and anxiety-related disorders.
The first lesson for me was breathing. When you’re in fight or flight your breathing changes and that gets you more anxious. So we spent a lot of time practicing breathing in through the nose two three four, out through the mouth two three four. I had to practice this at home too in a relaxed state, so I started identifying the breathing with being relaxed. Eventually taking a deep breath became an immediate unconscious response every time I got anxious.
Cognitive restructuring was another important lesson. With my anxiety I had these negative repeated thoughts, “you’re so stupid, you’re going to flunk out of graduate school, you’re a failure etc.” In this step, the therapist folded a piece of paper in half length-wise and on the left wrote each negative thought down. On the right we came up with something that was *true*. It’s really important here for it not to be aspirational or unbelievable, but for the response to be completely believable and true. Stuart Smalley-style affirmations don’t work. But replacing incorrect negative thoughts with neutral or positive true things does work (on average, in RCT). (And I decided what was true, not the therapist.) So “You’re so stupid” would be replaced with “I’m not stupid.” “You’re going to flunk out of graduate school” with “[Grad School] doesn’t flunk anybody out, they just give people consolation PhDs and make sure they work in industry instead of academia where they make more money.” “Even if I leave graduate school I’m not a failure, I can still get a real job making money.” and so on. I kept that original list on our refrigerator through several moves and really only didn’t put it back after our last sabbatical.
Progressive muscle relaxation was another interesting one. With this one, you start at your toes and clench them super hard and focus on how they feel while clenched. Then you unclench them and ponder how different they feel when unclenched. Then you go up your feet and legs and so on. I fell asleep in the therapist’s chair doing this and we decided maybe it was a bit overkill for test anxiety. But it does help me get to sleep sometimes.
There were more lessons after this, I think positive visualization for which the science wasn’t really there yet was one. I don’t remember what else. Breathing and cognitive restructuring really helped me. If they hadn’t worked so well, we might have done some aversion therapy which is NOT just throwing someone into a pit of their fears without support.
Anyhow, that’s my CBT post and now maybe instead of typing this all out each time it comes up in a chat I can just refer to this post.
*YOUR MILEAGE MAY HEAVILY VARY. CBT didn’t do jack squat for #2, although she recommends it to most people. Please don’t feel bad if 8 sessions of manualized CBT doesn’t fix your decade-long problems. It’s not designed for that. It works well for, say, test anxiety, or a first-time depressive episode. It works less well for relational trauma and complex interactions of problems.
Have you done CBT? What were your experiences with it?