Since I started this blog a few months ago, I’ve been meaning to write about my experiences with two particular kinds of therapy used to treat anxiety disorders. That’s because the first I tried, Cognitive Behavioural Therapy (CBT) is one of the most popular forms of therapy among mental health professionals, and at one time I believed it was the only path to mental health for me. But during the years that I applied the principles of CBT, I ended up with little more than feelings of frustration and failure, and no improvement in my anxiety symptoms. I assumed this was just the inevitable course of my illness, and my only choice was to keep on trying with CBT. I thought I had no other treatment options – until I discovered that there was something else out there: Acceptance and Commitment Therapy (ACT). ACT has worked for me in a way I’d given up hope any therapy could. And I’m here to tell you, if you’ve tried CBT and it hasn’t helped you, there are other options.
I’ll start my story properly a few years ago, when I first began to realize I needed mental health treatment. I did a lot of online research (typical for me!) into treatment possibilities, and all of my research was telling me that the best kind of treatment for anxiety (and for a lot of conditions) was definitely Cognitive Behavioural Therapy, or CBT. Mainstream CBT is based on the idea that it is not a situation itself that affects how people feel emotionally, but rather their thoughts in that situation. Followers of CBT are expected to identify and change their patterns of inaccurate, negative thinking, with the goal of viewing situations more clearly, and thus being able to react in a more appropriate, healthy way. (You can read lots more about CBT on the Mayo Clinic’s website).
That all made a lot of sense to me, so I set out to find a counsellor who could help me with my anxiety disorders, hopefully using CBT (this was a few years before I started seeing my current psychiatrist). I went with a counsellor available through my employer’s Employee Assistance Program (EAP), which had the advantage of being free.
An Uphill Struggle
As I’d expected, my EAP counsellor suggested I undertake CBT, and I proceeded to work diligently on all the exercises she gave me over the next several months. These were exercises like identifying my “cognitive distortions,” (that was pretty easy, as I had most of them!). Or keeping a record of my negative thoughts through the day (like “I think my employer might be planning to phase out my job” or “Maybe I’ve made a mistake buying this car”), and then challenging those thoughts by listing the rational evidence for and against them. It all seemed logical and sensible to me, and I figured I was on my way to recovery.
Now, when I say I worked on my exercises “diligently,” I think it’s probably more accurate to say I worked on those exercises like they were the most important thing in the world, almost to the point of obsession (and examining my thoughts also fit in nicely with my unhealthy tendency to engage in extreme over-analysis in response to anxiety). I wanted so desperately to get better, and I was sure this was the only way I could.
And I did get a bit better. I had started seeing my counsellor at my lowest point, and I was starting to feel closer to normal. My counsellor and I had a good rapport and she made me feel supported, and that helped a lot. Plus, I think the CBT did provide some benefit. It seemed to work when I was mildly anxious about something – at those times it helped me to look at things from a different perspective, and sometimes that’s all I really needed in that moment.
After a few months, my EAP counselling had reached the maximum number of sessions allowed (surpassed it, actually), and my counsellor and I felt like I’d made enough improvement to continue my CBT work on my own. I was determined to do that, and to really kick my mental health problems for good.
The trouble was, I found that whenever I ran into an anxiety-producing situation and applied my CBT skills, my anxiety might subside slightly in that moment, but it kept coming back: maybe the next day or next week, maybe just an hour later. Sometimes about the same issue, sometimes about a different issue. And I kept having to go through those CBT methods over and over again, constantly challenging my thoughts. Sometimes it would provide temporary relief again, but other times, when my anxiety was a bit higher, trying to be clear-headed and logical was simply beyond my reach, and I would be left feeling anxious and frustrated.
And so, over the next couple of years, I would try again and again to apply CBT principles to my anxiety, with only fleeting improvement (if that). I assumed I wasn’t trying hard enough or doing it right, so I redoubled my efforts to the point where I was challenging nearly every anxious thought I had, which, if you suffer from Generalized Anxiety Disorder, you’ll know feels like 50% to 90% of your thoughts on a daily basis, depending on how that day is going!
So that’s a lot of “anxious-thought / attempt-to-examine-and-challenge-thought / frustration-because-this-isn’t-working” cycles. After a while, I remember thinking “I’m just tired of fighting with myself all the time.” And I felt like a failure because my prescribed treatment, the one that seemed universally highly regarded, wasn’t working. And like a typical anxiety disorder gal, I assumed it was my fault.
A Ray of Hope
And so I went on for a couple of years, knowing I was still well short of my mental health goals, but also feeling frustrated and worn down by my ongoing use of CBT methods. I started to believe that maybe I had simply gone as far as I could go with my recovery (for now at least), and I would just have to make the best of where I was. I was wary of the thought of pursuing therapy again, as I figured I would be thrown back into the middle of the CBT storm. But I couldn’t help wondering sometimes if there were any more options for me out there.
As time passed, I began to reflect on the idea that the one thing I hadn’t tried for my anxiety was medication. Maybe that would be worth a go. I eventually gathered the strength to see a psychiatrist in the hope of trying some meds, and maybe receiving a fresh perspective on my issues. At my first appointment, I did get a prescription from my psychiatrist, but I also got two other valuable things that I hadn’t anticipated. The first was an accurate diagnosis of my conditions: Generalized Anxiety Disorder (GAD) plus Specific Phobias (my previous counsellor had always resisted sharing a diagnosis with me, but when I pushed her, she said she believed I most likely had OCD, which honestly just never sounded right to me).
Then my psychiatrist surprised me by telling me that CBT often isn’t effective for people with GAD, which gave me an enormous feeling of relief – so all along it hadn’t been my fault that I couldn’t seem to reach my recovery goals using CBT, it was just the wrong therapy for me. Instead, my psychiatrist suggested a book for me to read: The Worry Trap: How to Free Yourself from Worry & Anxiety Using Acceptance & Commitment Therapy by Chad LeJeune.
I’ve mentioned before how helpful this book has been for me, and that’s because Acceptance and Commitment Therapy (ACT) has been everything for me that CBT wasn’t: reassuring, empowering, and effective (ACT is actually a modified form of CBT, but for simplicity’s sake, in this post when I refer to “CBT,” I’m referring to mainstream, traditional CBT). I’d describe ACT (as I understand it) as being all about letting go of the struggle to control unwanted thoughts, and being mindful of the present moment (those ideas being the “acceptance” part), then committing to taking actions that are consistent with what’s most important to you (that’s the “commitment” part).
With ACT there was no more analyzing my thoughts to figure out what cognitive distortion I had fallen prey to this time, no more efforts to yet again try to reframe my situation in a more positive way, as there had been with CBT. Instead, for the first time, I just sat back and observed my worry thoughts without judgement, and without the expectation of figuring out a way to change them – in fact, I was told that focusing on my anxiety as though it were a problem to be solved (as CBT would regard it) would only make things worse, because it would mean that I was dwelling on my anxiety a lot of the time, amplifying its power and significance. And I was allowed and encouraged to let go of any urge I might have to control my thoughts, because my urge to control the uncontrollable was at the heart of my anxiety disorder. As Oprah would say, I had one “lightbulb moment” after another as I read my new book!
As I worked through my current therapy and began to understand myself better, I came to suspect that one of the reasons I hadn’t been successful with CBT was because CBT focuses on the thought process, supposedly using healthy, positive thoughts to overcome unhealthy, negative thoughts. The trouble is, once my brain gets into full-on anxiety mode, rational thought becomes virtually impossible for me, thanks to my brain switching to fight-flight-or-freeze mode (which I think is fairly common for people with anxiety disorders). So I don’t believe any treatment that requires that I apply rational thought in the midst of significant anxiety was ever going to work for me.
So now, thanks to ACT, when I start to feel anxious, I just allow myself to accept my silly anxious thoughts as they wash over me – I try to relax and ride the wave until those thoughts pass, just existing in the present moment as much as I can. (A good analogy of how ACT works is the “passengers on the bus” analogy, which I wrote about in detail in a previous post). If I’d still been using CBT, I’d still feel like I had to analyze those thoughts and attack them head on, leaving me feeling at odds with myself, plus I’d still be anxious about whatever it was that had made me anxious in the first place, plus I’d be anxious that I couldn’t make that original anxiety go away, and then I’d wind up angry at myself that I was still having these stupid thoughts at all, despite all my efforts. What a mess! No wonder I hadn’t gotten better with CBT.
As I embraced the ACT philosophy, I started to feel myself being released from that sensation of constantly fighting with myself that had come from applying CBT principles over the years. I was often reminded (and still am) of the song “Falling Slowly” by Glen Hansard & Markéta Irglová, particularly these lines:
“You have suffered enough
And warred with yourself
It’s time that you won.”
In addition to the benefits I gained from letting go of all of those unhelpful CBT practices, ACT itself has definitely been helping me to manage my anxiety better and better. It seemed almost counterintuitive to me at first that allowing my anxious feelings to occur without trying to actively resist them would actually result in a reduction of those feelings, but somehow that’s what’s happened – it feels as though now that I’m not struggling with my anxious thoughts any more, they’ve lost a lot of their power over me.
Mind you, I try not to think of the years I spent fruitlessly trying to heal myself with CBT as wasted. For example, I got quite good at applying CBT principles to help other people see their problems from a different, hopefully more positive, perspective. It’s all so much easier for me to see those solutions when my own emotions are not tied up in the situation. So I’d like to think all that CBT practice still has some value, at least for the people around me!
I have no doubt that CBT works for some people with some psychological conditions (and it probably works well for folks who do worry a lot, but who don’t have an actual anxiety disorder). It just didn’t work for me, and I was so happy to find that there was another alternative out there. That’s why I try to encourage people who are frustrated with the state of their mental health, even after seeking treatment, not to give up. Sometimes it’s just a matter of trying another treatment option, one that fits you better. You could wind up with a treatment that gives you renewed hope, which is exactly what ACT did for me.