Hi all. I'm about to start ten weeks of CBT with ERP for OCD, and I'd love to hear from anyone who's been through it.

The past few days have been really tough. Coming off a medication set off a bad flare-up of real-event OCD. It latched onto a complicated relationship from about six years ago, one that was resolved a long time ago. The last time I saw her, we were on good terms and she was genuinely happy to see me.

What the OCD fixated on was part of an old message I'd sent a friend back then. In it, I said she'd claimed I tried to have sex with her, and that she later came clean that it wasn't true. My brain zoomed in on the "tried to have sex with her" part, skipped past everything else, and started telling me I was an abuser, a manipulator, and that it was all my fault. I spent hours digging through old messages trying to prove it wrong, which only made it worse.

I had a one-off session with a therapist I've seen before, and it helped a lot. With his support I deleted the old message log, and I can now see the thoughts as unreliable rather than true. But they're still loud, it keeps finding new angles, and I'm still struggling.

I'm not asking anyone to judge what happened. I'm hopeful and I genuinely believe CBT can help, but I'm also nervous. ERP sounds hard, and part of me worries I'll find it too much or that it won't work for me.

If you've done CBT or ERP for OCD:

- What was it actually like, especially the first few weeks?

- What helped you stick with it when it got uncomfortable?

- Is there anything you wish you'd known before starting?

Any encouragement would mean a lot. Thank you.

Core beliefs like 'I'm not good enough' usually sit underneath a lot of different automatic thoughts, so they're slower to shift. One approach is to keep a running log of small pieces of evidence against the belief, even tiny ones, because the belief tends to filter those out. Working on core beliefs with a therapist can help a lot, since they're hard to see clearly from the inside.

Core beliefs like 'I'm not good enough' usually sit underneath a lot of different automatic thoughts, so they're slower to shift. One approach is to keep a running log of small pieces of evidence against the belief, even tiny ones, because the belief tends to filter those out. Working on core beliefs with a therapist can help a lot, since they're hard to see clearly from the inside.

We have all internalized fundamental rules about how life is supposed to work. They are the always barely present shoulds of our lives:

• I should do well in everything I do.
• People should always be respectful.
• Life should be fair.

According to Rational Emotive Behavior Theory (REBT), when these rules, which are in reality preferences, turn into rigid and extreme demands, our emotional and behavioral responses are likely to be equally extreme.

When "I should do well" becomes: "I must do well, and if I dont, Im a complete failure", the inevitable setbacks of life are likely to result in deep despair, shame, and avoidance.

When I should do well is taken to mean—"I want to do well, but I dont absolutely have to, and sometimes I wont"— our inevitable failures are more likely to produce healthier emotional responses and behaviors like disappointment and problem-solving instead of emotional paralysis.

Not every rigid attitude causes distress (believing the earth is flat and that horrible things will happen if you lose sight of the shore wont bother you much unless you fish the open ocean for a living.), but spotting the ones that do and transforming them into realistic alternatives is one of the more effective ways to internalize our locus of control.

What do you think is the most dysfunctional "should" a person can hold?

Exposure works best when it's gradual and repeated: make a ladder of situations from mildly scary to very scary, start near the bottom, and stay in each one until the anxiety drops noticeably rather than leaving at the peak. Doing it often matters more than doing it heroically. And drop the little safety behaviors if you can, since they stop your brain from learning the situation is OK.

So I have a couple phobias, one or two addictions I need to work on, trouble with certain social skills issues, and one or two dangerous habits I would like to change.

I have autism and mental health issues.

Are there any CBT support groups or individual therapists who can get me the formula for adjusting my own behavior so that I can DIY the rest in Los Angeles area?

A support group would be great. I have autism and mental health issues but I don't want another autism social skills support group because those aren't appropriate for me.

Please advise.

Exposure works best when it's gradual and repeated: make a ladder of situations from mildly scary to very scary, start near the bottom, and stay in each one until the anxiety drops noticeably rather than leaving at the peak. Doing it often matters more than doing it heroically. And drop the little safety behaviors if you can, since they stop your brain from learning the situation is OK.

How does CBT approach trypophobia? Does graded exposure work in the same way. Are there any contraindications to CBT for trypophobia?

With low mood the usual advice is 'wait until you feel like it', but behavioral activation flips that: action first, motivation follows. Pick something tiny and specific (a ten-minute walk, one dish, texting one friend), schedule it, and rate your mood before and after. The point isn't feeling great, it's collecting evidence that doing small things shifts mood a little. Those small shifts add up.

Hi there,

I hope you're doing well. I'm reaching out after seeing your posts and expertise on DBT.

I am looking for recommendations on an individual DBT or DBT-informed program specifically focused on interpersonal skills and co-parenting communication.

To give some context:

- Primary focus: Interpersonal effectiveness, boundary setting, and de-escalating high-conflict co-parenting situations.

- Diagnostic profile: There are no diagnosed mental health issues, personality disorders (e.g., BPD), or self-harm/suicidality concerns—only ADHD.

- Format preferences: A structured individual therapy or skills-based program is what I need. A skills group component would be very welcome if included or suggested, but I do not need 24/7 phone coaching or crisis intervention services.

Given that a full comprehensive DBT program might not be clinically necessary or the best fit for this profile, what specific individual programs, curricula, or provider types would you recommend looking into?

Thanks so much for your time and guidance!

Hello everyone! I don’t know if anyone has been or is in a similar situation or generally has some advice. I’ve completed my HIT CBT postgraduate diploma and I was a PWP for three years prior (one year as trainee). There are barely any CBT jobs in the nhs and none near where I live. I’m a mum and also have to take into account childcare needs and pick up etc (after school club latest collection is 6pm). I’ve now been offered a role with vita fully remote as a PWP which I’ve accepted on a part time basis 3 days a week. I have done this in hope that once I get my accreditation through I can do private work as a CBT therapist. However, I’m worried about the fact I’ve spent so long u learning the PWP way of doing things and I don’t want this to impact my competence clinically as a CBT therapist. I want to continue to develop as a CBT therapist not revert to PWP methods. Any ideas as to what could help me to ensure I develop my CBT therapy delivery and competence whilst delivering GSH as a PWP 3 days a week? Also, any advice on how to work privately best ways to get the right clients, therapy contracts etc things that help you?

The step people tend to skip is weighing the evidence. After writing the situation and the thought, list what supports it and what doesn't, as honestly as you can, before writing a balanced thought. If the new thought feels fake, it's usually because that middle step got rushed. Even moving belief in the original thought from 90% to 70% counts.

I've been asked to track my daily activities and emotions for two weeks, but I've spent years trying to avoid thinking about how I feel because of my ADHD and depression. Whenever I think about it, I start spiraling, so most of what I do is just a distraction from reality.

Now I'm being forced to control how unhappy I am with myself, my body and my life. It's depressing. I genuinely want help, but this whole process is making me feel more hopeless and I'm starting to wonder if I'm just wasting my therapist's time.

Who is considered to be a "DBT Specialist"? And what kind of DBT therapy would a "DBT Specialist" recommend? Is there a particular industry standard DBT certification or curriculum that is required to give DBT therapy?

I feel like these aren’t the kind of books you can simply read and put aside; the real work is in doing the exercises. For those of you who actually work through them, how do you go about it? Do you draw the tables in a notebook yourself, or do you use ready-made templates? I’d love to hear how you organize your practice.

Howdy r/CBT!

Recently I've been working with my therapist on CBT techniques like thought reframing, and I'm stuck on the "examine the evidence step." For context, I've been stuck in deep cycles of rumination, reassurance-seeking behavior, guilt & shame, hypervigilance, emotional monitoring, and catastrophizing my thoughts. We've worked on helping me build some helpful skills from different approaches, but I'm eager to develop my CBT skills as well.

However, I'm struggling with understanding how to examine the evidence for or against a thought, because it feels too similar to engaging with the rumination cycle.

For example- if the automatic thought is "coworker is mad at me" based off hypervigilance and emotional monitoring, when I try and find evidence for the thought, it's all examples of cognitive distortions and that digging for evidence/ engagement feels like it's feeding my anxiety and rumination.

Am I doing this wrong? If anyone has insight I'd really appreciate it.

I've had therapists ask me for years why I think having somebody else give feedback to my family would make any difference when I could just do it myself.

Well, that's kind of the point. They're not me.

There's actually a name for part of this: closeness-communication bias. People who know each other really well tend to assume they already understand each other, so they don't necessarily listen as carefully. Sometimes it's easier to get through to a stranger than someone you've known your whole life.

I've experienced this from both sides. I used to work as a physical therapy aide, and a big part of my job was getting patients past their excuses and resistance to doing their exercises. I'd give them direct feedback, challenge their excuses, and help them take responsibility for their recovery. And it worked. People would come back more motivated and actually seem to appreciate being pushed.

I've even had this work with my own father. I can talk to him about how he's treating someone else, and he'll actually listen and change his behavior. But when I'm the person he's mistreating? Completely different story.

And yet therapists seem to act like it's some mystery why I would want an outside professional to give my family feedback.

They also seem to assume I haven't already tried talking to them, explaining things, setting boundaries, etc. Of course I have. Hundreds of times. The problem is that my concerns get dismissed, deflected, or turned around on me.

What really bothers me is how many elaborate explanations therapists come up with for why they can't or shouldn't directly address harmful behavior.

I'm not asking anybody to magically fix people or force them to change. But what's wrong with simply identifying unhealthy behavior, explaining why it's harmful, and teaching people what healthier behavior looks like?

Instead, it seems like the responsibility gets dumped on the person who's already dealing with the behavior. I've had individual therapists ask things like "Why do you continue to allow these people in your life?" And when I try to explain that my family members aren't all bad, or that the situation is more complicated than that, I've actually had therapists argue with me about it.

There's a huge gap between healthy behavior and behavior bad enough to involve the police. Who's supposed to help people deal with everything in between?

I see therapists complain about being blamed for breaking up families, but from what I've experienced, they absolutely contribute to it. Rather than helping address the problems, they push the responsibility onto the person being harmed and often end up further undermining them.

This hasn't just been unhelpful in my experience. It's made abusive situations worse.

So why is there so much resistance to giving people direct feedback about harmful behavior? And at what point does refusing to address it become enabling it?

Short map of the protocol, because the jargon is the first barrier and nobody explains it in order.

Sleep diary, week 0. Before anything changes, you track. Rough morning estimates — when you went to bed, roughly when you fell asleep, how long you were up, when you got up. Two weeks of this gives you your actual sleep time, which is almost always different from what you assumed.

Sleep window, week 1. You set time in bed to match the sleep you're actually getting, not the sleep you want. If you're sleeping 5 hours across 8 in bed, the window becomes about 5.5. Wake time gets fixed first, bedtime moves later to fit.

Stimulus control, ongoing. Bed is for sleep. Awake and frustrated, you get up. This is what rebuilds the association your insomnia broke.

Titration, weeks 2 onward. Weekly sleep efficiency goes up, the window expands 15 minutes at a time. Efficiency drops, you hold or trim.

Cognitive work, throughout. The catastrophizing at 2am, the arithmetic about how many hours are left, the belief that tomorrow is ruined. This part gets skipped constantly and it's half the treatment.

That's the whole shape. It usually takes 4 to 8 weeks, and it gets worse before better.

Not medical advice — sleep restriction isn't safe for everyone to self-administer, more on that in a separate post.