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I always thought I wasn't alone. Now I realize just how alone I've been. It is much easier to write in terms of factual occurrences, after all there's no reflection of inner thought, just simply passive memory. I always used to think that people thought like me, and that ideas and logical inferences came easily to them. I know realize that is not the case. People don't think like I do, and I've met very few who've been able to understand. I mean truly understand life.

What is life? Factually it is the result of unfathomable cellular and organic interactions. That is perhaps the deepest any sentence can scientifically go with current human understanding. No, I can't speak as a principle lecturer to an audience of people dressed in suits. I can't lay a brain on the stage in front of all of them and point with vehement declarations as to the "this's" and the "thats" and explain away all there is to consciousness and all there is to life.

For life is beyond my mind. Indeed it is beyond any persons. I suspect I will die without actually knowing what life is. And if that fact, that realization doesn't absolutely fill your soul with sorrow, then you quite frankly, haven't been thinking enough.

I've lived 22 years, some times have been good, some times have been bad. Lately bad. I wish more than anything to get my health back, to feel like old times, but I wonder if hope abandons me. Pain and suffering is pretty much all I've known thusfar in my life, and yet I refuse to believe that's what life is. Or sorry, I mean, I refuse to believe that is all of life's purpose. Perhaps it is a remnant of some noble species, this theory of hope without evidence. Somewhere in the genetic line a successful species had to have developed characteristics to withstand hardship, as the world presents many.

No the origin of hope and future thinking is also beyond my mind, though I care to enter into it with speculation. But I do feel that gift given to me that I have not forged myself is that much the stronger than the hardships given to me. That despite everything I still persist in the idea that I can do great things. Counter to all evidence perhaps, but I do not now accept the notion that I am defeated, though much of my former strength is gone I have resolved onto myself this final journey in my life. I do not know how I'll get there, but I do know that everything in my heart and that remains alive is focused on it. That strength that I possessed, if still alive, will come back to me whence it is ready to be summoned, and for now I shall do all that is left in my will to see to it that I accomplish my dream.

For I live in the time scale of decades, to which is not even felt by the Earth, and that life which has been in existence for billions of years, will care not about I or any manly society's story, I am as insignificant and profound as all the rest of this universe. That god has made us of equal worth, that much I feel is true. That if you take a ratio with any one thing, be it a man, a king, a president, a star, a galaxy - anything, and you compare it to all other things, that is, you compare it to the universe. You find the ratio is the same, for anything divided by infinity, is always zero.

All things ratio to zero, and hence, in a small way, all things are equal.

Antagonistic action

So actually this picture was taken about two weeks ago. It's just that it has been finals week for me and I've been buried. Just buried. Under lots of work.

Well this all became possible through my physics club at school (the department paid for most of the expenses). When I heard they were offering students slots in a skydiving adventure, I figured, what the heck? I feel like risking my life. So I signed up!

As you can imagine, the whole lead up to the situation was quite nerve wracking. I somehow got it in my mind that my harness wasn't properly strapped, and that I was going to fall off and die. Oh gosh. AND THE PLANE RIDE!! OMG! It's like "WTFWTFWTF x 20" As you're climbing up so high you're looking down at the clouds and the door to the plane is open and you're not attached yet. Nothing to hold onto either.

Anyways, enough about the negatives.

OMG LYKE IT WAS THE BEST THING EVER!

When I jumped out, it felt like I entered into this wind tunnel. Actually I was going about 54 meters/sec. Which as you can imagine, is a lot of distance in little time. As I looked at the Earth, it didn't look like it was moving. There's actually a physics argument about the focal length of your eye and what not ... but anyways the gist of it is, is that you don't actually feel like you're falling until you get much closer to the Earth and see the ground moving quicker.

For about a minute I was in freefall, just feeling the wind burst into my nose and cleanse my brain, it was such a purifying experience. It was such an amazing experience. It's something I recommend everyone do, sometime in their life! I wish I could write more but I have to get rest. Maybe I'll continue this later.

EDIT: if you're wondering what my hand sign thing is, it's actually the hand sign of my college, UT longhorns.

Clubbing

I'm sure I would not have been able to go clubbing before my CBT. Even still, I just like 90% of the other people there had to rely on some alcohol to get me going to the club. Last night was so much fun! I danced on the dance floor until I was literally drenching in sweat. I didn't dance with a girl but that's not what matters, what matters is that I went and had a good time. Afterwords I chatted up some girls and had some success there, also things I couldn't have done otherwise.

So I'm at a point where I'd say that my SA is mild to moderate, but with some alcohol gets completely taken away. I'm still not quite satisfied with that because honestly I don't like drinking and I don't want to be become reliant on drinking.

So there's still significant improvements for me to do. I'd just like to ask the readers of this blog if they've ever gone clubbing, or if not, what they're afraid of happening if they do go?

CBT: Everything I've learned.

SA sufferers enter CBT generally with the goal to reduce their physical symptoms of anxiety as well as lower their (perceived) inhibitions. This is an appreciable goal, afterall seemingly the only thing separating us from "normal" people are the physical symptoms and inhibitions (although one might classify inhibitions as being apart of physical symptoms). However, this becomes a problem goal when one makes this the focus of their treatment. CBT does not directly address physical symptoms, nor does it directly address one's inhibitions.

The theory of CBT is simple. Your symptoms of anxiety are coming from your negative interpretations of reality. In this way, CBT goes for the "cause" of your anxiety. That is the magnitude and strength of belief you have in your negative interpretations. In the case of social anxiety, it is ALWAYS the case that you "fear" people noticing your physical symptoms. Your physical symptoms themselves are not generally distressing, you don't have them when other people are not around, they're tied explicitly to your interpretation of what other people think, react, and believe when they (might) notice your social awkwardness/physical symptoms.

In this way CBT addresses your "fear" not your physical symptoms, but your actual "fear" how afraid you are when a given situation occurs. The technique for this I will detail in later paragraphs, but I want to make it absolutely crystal clear what I'm saying here. I will restate it in two ways, once again another way, and once again in an example.

You're not addressing your physical symptoms/inhibitions during CBT, if you continued to experience physical symptoms of anxiety with the same intensity, but you were able to go to clubs, go to parties, talk with strangers, go on dates, etc. then you wouldn't be classified as having social anxiety disorder. I know that sounds odd but it's true! But actually what you'll find is that by focusing on addressing your "fear" instead of the intensity of symptoms, your symptoms actually begin to reduce themselves!

Now for an example. About a month ago I gave a presentation at a toastmasters meeting. This was to a large audience, and I wasn't given the topic ahead of time. I felt no fear before hand, I didn't even know when I was going to be called on. Because I had gone through CBT, and I knew that even if the worst thing happens, even if I become a blubbering idiot and pass out and urinate on myself and catch on fire, I WILL BE ABLE TO HANDLE IT! I'm perfectly safe! I didn't hesitate at all when they called on me to go up and present. I went up there, and I had a massive panic attack, I ran out of breath, and my heart raced and everything. But I wasn't accepting any ideas that I was being negatively evaluated or that what I was experiencing was making me a complete loser. I ended the speech, went back to my seat. Didn't reflect over it, because I was perfectly  happy with what I was able to do. I didn't care if other people thought of me negatively or not (none of them likely did) because I knew what I was there for, I want to get better and if people I never see again judge me negatively then they're heartless losers who don't know shit about me or my situation.

This past month I have felt my physical symptoms of anxiety and inhibitions begin to diminish dramatically. As my fear levels have gone down I have been going to clubs, going out with friends, making new friends, and even talking up girls!

So, this is how CBT works. It addresses your fears. It addresses your beliefs and cognitions. The most effective way it does this is by having you do extended exposures until you begin to realize that you're ok and safe in particular situations and when you remove your inhibitions. It's like learning how to swim, people take you slowly deeper and deeper and once you convince yourself you won't drown all of a sudden you're Michael Phelps!

There are medications that will speed up this process, but I don't want to talk about it here, it's something I need to have an extended conversation with.


Exposure exercises in my honest opinion must be begun in lab settings. You have to be able to be given discomfirming evidence. For me we repeatedly had audiences fill out "feedback" forms for me about how they were actually perceiving me. This helped so so so so soooooooooo much that I can't even begin to think how anyone can do CBT without this feature in their exposure exercises. It literally opens up your mind and lets you see this dimension that didn't exist before. Never in the past could I have imagined what I actually came across like and how people actually were perceiving me. So much of SA is grounded in this false idea on how you're coming across, how people are perceiving you. Well what better way to counter this than to get their actual opinions! Also, just doing extended exposures was an immense benefit because you begin to melt your anxiety away and it gives you this surge in confidence in your ability to handle difficult social situations.

During exposure exercises it is ABSOLUTELY imperative that you engage in "antagonistic" actions. That is, doing things your brain is telling you NOT to do. That is how you destroy inhibitions, and it's what allows you to experiment and discover just how safe you actually are in social situations and how much people appreciate your non inhibited self.

Also you must drop SAFETY behaviors. Things like holding your hands in your pockets, or modifying your voice to make you sound more confident, or listening in on your voice to make sure it sounds ok, or looking down... in fact one simple antagonistic action is to purposely look at people in the eyes when you're talking with them. Actually you'll find that dropping safety behaviors (and you need a therapist to help you identify your own particular safety behaviors) because everyone has their own unique brand of insanity. My own safety behaviors was rocking back and forth (fidgeting) avoiding eye contact, and paying large attention to how my voice was sounding. If you don't drop your safety behaviors during exposure exercises you will make no progress. NONE!

Cognitive exercises are useful in the sense that they keep you commited. I mean keep your thoughts committed, like filling out forms and identifying negative thoughts. But honestly, the only way to change your interpretation of reality and your fears is to aggressively expose yourself to the situations.

7 facts about me

Since I don't know 7 other people with blogs, I won't tag other people. However, since I saw that I was tagged on Janey's blog I'll go ahead and do the 7 facts.


1.) I'm graduating this semester

2.) Out of all the intellectual disciplines, history is my favorite.

3.) I can pop my knuckles without touching them.

4.)I got a college scholarship :)

5.) I was physically stronger when I was 17 then I am now.

6.) I prefer cold climates to hot ones.

7.) I've not broken a bone to my knowledge.

CBT: What works and what doesn't work.

Ok, so I completely failed at maintaining what I wanted this blog to be, and that was updating throughout the process of treatment. It's just I've been completely busy. This semester my work hours got upped to 20 hours a week, and then on top of that my school work has just been a never ending flood of homework,tests, and projects. On top of that I've had to go to career fairs/interviews and hope to goodness I'll have a job by the time I graduate this semester..

Anyways, enough about me.

So, things I've noticed that work in resolving the symptoms of social anxiety disorder. First and foremost, like I said in my previous blog entry, each person with SA has slightly different "physical symptoms" or ways in which their SA shows itself. For me, it was a suffocating sensation of running out of air when I talked and in addition my mind going blank during social interactions. Why do I say this? Well, if your goal is to treat social anxiety, then most likely you want to reduce the intensity and frequency of symptoms. So in order to do that you need to know what symptoms are bothering you specifically, and be able to attach "intensity" ratings to it throughout your CBT.

So I've come to figure out that CBT is not about desensitizing you to socializing. Rather, it's about building a new way to think when confronted with social situations.

So things I've found that assist in accomplishing this. First, prolonged exposure exercises such as what I've described in the past would in fact engage the new behavioral process. I would find that the "physical" symptoms of SA were significantly lessened a few hours after exposure, and indeed up to about a day or two after my exposure session. However, the positive effects would drop off and a renewal of intensity in the physical symptoms would occur roughly 2+ days after my exposure exercise.

In order to combat this, I increased my exposure exercises to twice daily, followed by daily cognitive exercises in filling out "thought" records. I will go into detail about thought records later. This allowed me an easier time to maintain CBT effects longer, and it made it easier for me to engage my "new" way of thinking about social interactions.

The effects of this I can state mainly as follows: there were times where I was able to interact socially with minimal to no social anxiety. Such as going to the movie with friends, talking with female friends, and interacting with coworkers. This was solid evidence that my therapy was working. However, there's still a large problem of oscillation between a non-SA state and a SA state. I find that I am better after exposures but the longer I go without an exposure the more my brain degrades back to a SA state.

Speaking of being extremely busy, I don't even have time to finish this entry, I'll continue later.

Confronting your issues

Most problems in life can be imagined to behave like a hill. That is a raised ground that presents an obstacle to you. Now in presenting this type of thinking it helps the metaphor to think of the solution to these problems as a nice warm bath of clean fresh water at the top of the hill. All you have to do is get there.

Now obviously some hills have varying levels of steepness, varying levels of height, and varying levels of traction.

Social anxiety disorder can be likened to a marble hill of >60 degree incline. It's easy to climb a few feet and then lose your traction and slide back down to the ground. In this way it can certainly feel discouraging to pursue treatment.

But the good news is that the hill is not necessarily symmetric. There are steeper but more promising paths towards treatment. I've found that this truth can be extended to many other problems in life, that a direct path - though causing more severe pain will get you to your solution faster and with many times more success than trying to go around the hill or taking varying paths to get there.

CBT is that direct path, and though it entails a lot of hard work, if executed properly, can get you the relief you need.

What's wrong with mental health in America.

There is a large disconnect from the promising realities of what we read in scientific studies on mental health and well the real world.

CBT is a viable treatment option if it is being practiced by an extremely well experienced and wise practitioner with adequate access to resources such as volunteer people to use in exposure sessions. The wide array of psychologists/PhD in the private practice are so alarmingly underskilled, inexperienced, and full of utter BS that it's not only not helpful to see them, it's HURTFUL to with each sessions charging 200+ dollars?

Seriously? These the people who come down the ladder of liberal arts colleges presumably under the false philosophy of being liberal philanthropists, but it seems in reality they have no qualms indulging the more "pragmatic" aspect of communist philosophy i.e. some people are more equal than others.

I've done the searches in private practice and without exception to all those who claimed under the never ending list of skills to be "CBT experts" were nothing more than pseudo intellectuals who haven't cracked open a recent study of CBT let alone a textbook or any source of information on the subject since they passed their qualifier in graduate school if they even looked at it then. They instead seem to uniformly rally around their own crackpot theories as to how the ole' noggin works and are ever so satisfied implementing their own unscientific "intensive" talk therapy treatments that I wouldn't mind betting my entire valued worth do nothing to alleviate the symptoms of clinical anxiety disorders.

I've been lucky to go into a research clinic at a university, and I know what it takes to make progress in treating social anxiety through this method, and I know that it takes intense commitment and ability to withstand intense pain.

From this learning experience, I know that the vast majority of people who read the CBT studies and think all it takes is a quick call to get on board a program to change their lives are deluding themselves. For one thing, if you call any mental health practitioner in this country - go ahead - you'll find that ~80% aren't accepting new patients and those that are have a >20 day waiting list before you can be accepted.

Just being accepted to see a qualified mental health practitioner itself is a feat.

But that's nothing. Like I mentioned before - realistically speaking the odds of the person you called being able to take your insurance is probably around 30% assuming you have a large insurance plan. Now the odds of that person accepting your insurance plan AND being competent to practice CBT is probably around 1-2%.

That means 1 out of 100 mental health practitioners will be able to accept your insurance plan and be competent to treat you.

Are you feeling lucky?

Of course these numbers I'm using aren't by any means scientific, they're just based of a small limited pool of psychologists I have researched and done "first visits" with.

It is so darn depressing, the immense backlog of mental health in this country. There is absolutely no reason for patients to have to wait 2-3 months to see a qualified mental health practitioner especially with the intense level of pain they have to suffer with. Then to receive inadequate treatment further compounds the problem as this forces patients to have stay with the practitioner thus preventing other patients from getting in and just compounding the issue of time to treatment further.

The state of mental health treatment options are just so horrendously bad and it is in such a dismal and pathetic state that it erases all doubt from one's mind as to why people with severe mental illness go long periods of time without adequate treatment.


In order to solve the problem, I propose several changes to be made.

I. Change the education pathway of psychologists. Just like there are specialties in medicine, there should be two fields of clinical psychology: one for depressive disorders such as major depression, dysthymia, unipolar depression, atypical depression - and other field for anxiety disorders that focuses solely on CBT-based treatments.

A third field of general psychology dealing with subclinical problems such as social/relationship/behavioral issues should also be a career pathway.

This act alone, would immensely assist in the problems I listed above. First, it would allow prospective patients to identify which type of psychologist they should go to rather than having to guess as to the psychologist's expertise with their problems. This cuts down on "false-start" sessions where a person takes up a valuable appointment time slot and wastes money on a psychologist who really isn't fit to treat them.

Second, it focuses the psychologist's study into the issue they're concerned with treating. This means staying up-to-date on research, gaining solid experience with what works and what doesn't and allowing this constistent exposure to the treatment process to allow them to become experts.

For clinical disorders not well categorized in these fields, these patients should be reserved for psychiatrists who can prescribe medications i.e. illnesses that only respond to medications such as bipolar disorder, clinical depression, schizophrenia, etc etc.

Will write more on this subject later.