Questions and therapies: why CBT might not be for me

I have heard a lot of people either swear by the system of cognitive behaviour therapy (or CBT – not to be confused with cock’n’ball torture!) or criticise its misuse or poor delivery (the criticisms being more common recently). The idea that it might be used in jobcentres being a particularly bad example of a misuse.

However, while I had a vague idea of the concept, I didn’t know much about what’s involved until today I saw at Beyond The Binary an article which cited an exercise:

Not everyone gets on well with CBT, but it was a lifesaver for me – maybe give this a try, and see if it helps you? Get a sheet of paper – a large one – and write down your main fear. Maybe that fear is ‘I’ll regret the changes I’ve made’ or ‘I’m not sure I know what I’m doing’. Then write down how much you believe that fear – how much you believe it when you’re feeling calm, and how much when you’re feeling panicky. And then, scribbling all over the page, start to break that fear down. What, genuinely, is the absolute worst thing that could happen? How likely is that outcome, and what would you do if it did happen? How much is it simply a natural fear of the unknown, or of making a mistake? How much is a fear of losing control?

This puts me in a place to say why the popular conception of CBT is unlikely to be helpful for me.

The simplest way to put it is that, the way my anxiety, or depression, or stress, or whatever it is that makes me panicky about stuff, works is that it plays these questions in my mind all the time. I overthink everything.

“What’s the absolute worst thing that could happen?”

Well, I’m a writer. It’s pretty much my stock-in-trade to imagine the most horrendous things and make them happen to my poor, innocent characters. Even if I wasn’t doing that, I have an imagination that conjures every scenario, and of course the worst can leap out at that.

How likely is that outcome?

This is where it breaks down. Things that people tell me are unlikely, and bad, have happened to me. Things that should be likely, and good, have failed to materialise even when there seems no reason why they wouldn’t happen. So when these questions run through my head, and I reassure myself that it’s unlikely that the bad versions have happened/are going to happen, there’s always the voice of past experience to say, “Yeah, well, you said that last time and look how it turned out.”

I don’t have a sense of how likely or unlikely the bad things are because experience tells me that those Bayesian probabilities are no guarantee of what actually does happen in my particular instance.

What would you do if it did happen?

Again, this is what I think about all the time. When I reviewed The Never List, I wrote about my own “Never List” type thought processes:

When I read thrillers, or watch movies, I picture myself as the victims: “How would I avoid this situation? Could I survive it if I found myself there? How would I do so? What would I feel, and could I handle it?” As a result, I have a version of a Never List which is more like an “Action-on List”. I sometimes joke about it, “What would I do in the zombie apocalypse?” but it’s ever-present. I don’t walk across darkened spaces, at least, not without a torch that I use to scan all around. I always sit facing the door so I can see what’s coming. I hate having someone be just behind me. I have my own Never List.

I imagine scenarios, and then I try to think my way out of them before they happen: how will I avoid being in this situation? If I find myself in this situation, how will I deal with it, and what are my chances of surviving (or of meeting my minimal goals, or of avoiding unacceptable losses)? What will I do, and how might things turn out?

Obviously, these thoughts do very little to calm my nerves: they help to drive them!

There is the retort that thinking is different from writing, and this is true up to a point. The aim of taking the time to put it into a concrete form, and then re-evaluate, is going to change the context.

The interesting part is the comparison between “how much you believe it when you’re feeling calm”, and “how much when you’re feeling panicky”. For the most persistent fears – the ones that prompt the most stuff on my never-list and action-on-list and are referred to most frequently – I don’t think the level of belief changes; what changes is how far I can put them from my mind, or how relevant they seem to the specific situation (e.g. “I might be assaulted in the dark” is not very relevant when i’m walking in the middle of the day, or sitting at home on the computer).

Writing the things down, I believe, does help create a more dispassionate perspective on those beliefs, but the process of re-evaluating them to me seems impossible, because it requires evaluating – and my problem is that I can’t put values on the “how likely is it?” or more accurately, I come up with multiple valuations of the fears.

There is also the difficulty that, when bad things haven’t happened, sometimes it can be directly attributed to the fact that my fear made me go through the never-list type of process and that helped to make sure that the bad thing that could have happened, I successfully averted.

I suspect that, administered by someone with a lot of in-depth training and more awareness of the types of issues that I have, CBT might over time produce something positive for me in terms of reducing anxiety. But I remain sceptical, and the above goes to illustrate why.


About ValeryNorth

I overthink everything.
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2 Responses to Questions and therapies: why CBT might not be for me

  1. This is exactly why CBT does not work for me as well: Thinking up the absolute worse scenario of a situation is what I do best!
    Nope! Not going there. I’ll live in my ignorant bubble, thanks.
    Another aspect of CBT that doesn’t work for me is: Make a list of all the good things that have happened to you today, and make an effort to appreciate them.
    Well, I know that good things happen, and I feel like a crappy depressed mess anyway … and now I feel even more crappy because I’m an ungrateful butthole because I have no earthly reason to feel this way … So now, I’m a failure and an ingrate.
    Honestly, drugs (the legal kind) and the science behind my brain chemistry help way more than CBT.
    Also, CBT helps more than CBT. LOL.

    • ValeryNorth says:

      Spot on!

      I’ll be honest, sometimes taking stock of what I’ve achieved/went well does work for me in fighting depression. But that’s different from “good things”, it’s “things that I made happen”. I swear by a book called Get It Done When You’re Depressed (by a fellow sufferer) if you’re looking for tips.

      But that whole “gratitude” thing: this piece is really a similar issue to that, for me, How much harm do you have to survive to be a survivor? Being asked to feel gratitude/appreciation of the good things can sometimes feel like, “Well, just be thankful it wasn’t worse!”

      Thanks for your comment!

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