Ok. Time to hold my hands up – I’m in therapy. I’m nearing the end of a course of Cognitive Behavioral Therapy to help me deal with anxiety. Up to now there were only three people who knew this: me, my wife and my closest friend.
Cognitive Behavioral Therapy (CBT) is a therapy that is designed to teach new ways of thinking, to provide the client with new ways of dealing with problems that they face in their lives. It is very important to bear in mind that it does not promise any cure: in my case it will not stop me feeling anxious in certain situations. What it will do (I believe and I’ve not yet experienced anything to contradict this) is give me tools to manage my anxiety.
One thing that has struck me throughout the course is how obvious it all seems. In short, the steps have been to identify the causes of anxiety and rank them in order of severity, start at the bottom and develop ways to handle them. It’s that simple! But there’s something significant about the fact that the advice comes from somebody who has no emotional connection, who is impartial and nonthreatening. I feel that they have no “hidden agenda”, that they are not trying to manipulate me (even though in fact they are – that is the purpose of the sessions). It comes down to trust: I feel that I can trust my therapist and consequently I am very accepting of her advice.
The thing about CBT is that it is a learning experience like any training course. If you are not engaged then you will not learn. Period. I believe that if you don’t want to learn something then you won’t. You can sit through lesson after lesson but if you don’t apply and practice what you are taught then you won’t learn. I think this is why CBT gets some negative reviews – people come into it expecting some silver bullet that will cure them of their problems, but it doesn’t work like that. The sessions with the therapist are just to provide the foundations. It is up to the client to build upon them by practicing the coping techniques learned. It’s difficult to begin with – you have to expose yourself to the challenging situation before you can try to apply the lessons.
I guess people fail because they don’t put the effort into this part. But as I said to my friend earlier tonight, I wouldn’t have brought this up with my GP if I didn’t want to try to fix my problem. And if that means I have to do “homework” then I’m going to put the effort in because the end result will be worth it.
I did some research about CBT before I started the course – that’s my way – and the key fact I learned about it is that it does not claim to be a cure. In may case it will not stop me feeling anxious. I believe it is important to go into this kind of therapy with realistic expectations of the outcome, and in my case it was that it would not stop me feeling anxious – it might not even make me less anxious – but it would provide me with ways to handle that anxiety, to function despite the feeling.
In many ways the success of the treatment depends on how much effort the client is willing to put in. The key to graduated exposure (which is the type of CBT I am receiving) is that you make the effort to expose yourself to the situations.
I’ve found that one of the hardest aspects of this for me has been to remember that I have to attempt to interact with people differently. Remembering this instead of falling back on ingrained habits has been very taxing mentally. I’ve discussed this with my therapist and she agrees that being on the autism spectrum poses particular problems for this type of therapy: resistance to change, ingrained habits (routines), co-morbid conditions such as social phobia and sensory hypo- or hyper-sensitivity, and difficulties interpreting non-verbal communication.
To this end I’ve been set tasks including listening to the radio (interpreting conversational voices) and summarizing what I’ve heard, observing other people’s conversations (which is one of the most difficult tasks – trying to derive rules for conversation based on observation, because it involves trying to interpret the non-verbal signals), and making phone calls (to my friends initially – it’s starting small but if that’s where I want to end up then I’ll have to build my way up to it.
I reckon I’ve made progress, even if it’s not easily quantifiable by the simplistic measures recorded by the questionnaire I complete before every session. And that’s the most important part – as long as I feel that I’ve progressed and I feel more able to tackle these anxiety-provoking situations then I think I’m gaining a benefit from the therapy.
So, in summary, I believe it’s only effective if the client is prepared to put the effort in to practice the skills being imparted. If one doesn’t have a realistic view of the aims and purposes of the therapy and isn’t prepared to put in the work involved in learning the skills presented, then it simply won’t work. In this type of therapy the therapist is the pilot guiding the course but the client is the engine room providing the momentum.