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.

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?

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.

I have felt, like a sense of in a situation that I am abnormal. I am not abnormal, but I feel I am sometimes, just invisibly to others.

I have felt like that since I was a child.

Context:

In toddlerhood, I was playful, active and healthy.

Examples: I stomped going up and down the stairs, made funny faces, danced to songs etc. I was quite good academically and got As in Kindergarten.

In childhood, I was active and jumpy.

Examples: Talked nonsense, played with my little sister pretend a lot. Had quite a hard grip and force when I played with my sister and then she would cry and our parents would scold me that I am older, and my force is stronger in reality than my perception of it. I often felt angry and sad, and kind of started to isolate from my sister that I harm everyone in my way so I should just stay away. But, I never really was able to isolate myself, I had very low self-control. I used to sit right into people's personal spaces, touched their skin (face, arms, hands), annoyed them. My grades were good (before grade 3).

In early teenage, I was very cringe.

Examples: I used to just blurt out things like that whether or not they were appropriate for the social setting. I got irritated from normal things. Didn't eat vegetables, ate a lot of snacks. My grades were barely making it to Cs and Ds (grades 3.5 - 8)

Around age 15, I was still quite cringe and had shame for not being like my cousins.

Examples: One time, I had henna on my hands (we were making tattoos) and I washed them, but it still had some left and I placed my hands onto the sleeves of my cousin's favorite shirt and it got ruined. I felt pretty bad that I did that. Similarly, I had a lot of these impulsive things, and I just stopped.

I also started having voice problems, my posture was leaned forward, I had slow movements. I fidget a lot. I have BFRBs. I avoid demands a lot.

My therapist told me after a sensory profile:

I also have sensory sensitivity, low registration, low sensory seeking and slight high sensory avoidance.

With voice problems, I still have them. I don't know how to speak clear. I mumble or intertwine words that leave my mouth and the other person doesn't hear it clearly. I have to repeat so my times. I don't know if I am speaking loudly or low. I don't know if my speed is normal or slow. I talk very slow and don't open my mouth wide enough that words get lost inside my mouth before going out.

My posture is still leaned forward and I do not know how to walk normally. If I straighten my spine, I look unnatural like forcing myself to be straight.

My walking speed is slow, my movements are slow.

I fidget a lot since my tween age. Bouncing/shaking my legs, rocking my torso, swaying, wiggling my toes.

I peel my skin off my fingers and lips.

Onto the Title:

I feel abnormal.

An example I will give that happened just now when I felt like that:

I am at my aunt's house. There are my cousins here too. So, it was evening and we hadn't eaten in a while, so my aunt told my cousin if she could make her black tea. My uncle also told her how much he wants and my aunt said that I also like black tea so, my cousin should make mine as well. My cousin asked her mother (my aunt) how much I would want. My aunt said to my cousin to ask me directly because she doesn't know. (I was around them the whole time) Then my cousin asked me how strong I would like it, and I was going to answer her, but I think I was slow to respond and I kept saying, like. Then my cousin said said to my aunt that I am just saying, like, like, like. I got embarrassed, but I managed to say, half, however, I wanted a full mug. And then I didn't say anything. That time I felt like I am not normal.

I don't know why my response time is so slow. I am just realizing this now that when someone asks me a question, I am thinking of an answer instead of answering. And just when I am about to answer, they repeat the question and it makes me feel self-conscious. And it's happened so many times.