299 - CBT for social phobia : an overview

Today was a special day for me, as it's the completion to 25 sessions & 17 months of CbT for social phobia, and marks the end of a cycle and a shift to the next stage of my healing, as well as a preparations for a new CBT.

Indeed, I finished this part of my healing path for social phobia, which I'll continue independently and alone, to perfect what I learned and to further my exposures on a regular basis, until the overall anxiety level reduces even more than it has thus far. 

Today, I gave the last sheet of Liebowitz Social anxiety scale (LSAS for the intimate), contrasted with the 2 previous ones ; showing both the path ahead, but also the road already covered as my anxiety levels reduced moderately, but my avoidance was even significantly lowered. 

This is the English translated overview for my 3 LSAS tests. There 24 questions each. 
The Red numbers are those of anxiety levels, the black are avoidance levels. Each of these are measured in 0, 1, 2 & 3, expressing in terms 

• Anxiety = 0 none, 1 is light, 2 is medium, 3 is severe
• Avoidance, 0 is never, 1 is occasional from 0 to 33% of cases, 2 is frequent 33-66%, and 3 is habitual avoidance, between 66 & 100% of the cases 

I also indicate the types of situations, S for Social, so things like gatherings,parties and so on, whilst the P, so-called Performance, are situations where one is observed and, potentially, being rated or reviewed for one's capacity, for example in exams. 

At the bottom, there are totals for anxiety, and avoidance, and again, per type. 
From LSAS to the next, I also signal in bold the changes, which are usually improvements, but on more rare cases, worsened conditions. I explain those either at increased frequencies of situations that I had to attend, and thus experienced more anxiety and/or avoidance, or, in other cases, the lack of exposures - say the P type ones that I didn't do as much seem to have been either stable or gotten slightly worse. 

Lastly, on the bottom I indicate the specific CBT session after which I had to fill my LSAS test.
1, the very first, was on 7 June 2016, a week after my session
16, I did 2 days after my session, on 2 March 2017, almost 9 months after the first test
24th session was 6 November 2017, but I actually filled my test 19 days later, and 2 days before my 25th session. This one is 8 or so months after the second test, but with half as many CBT sessions, and a much higher frequency in exposures, which, to me, explains both improvements as well as those rare worsened anxiety and/or avoidance cases. 

The most important parts are my overall anxiety, and avoidance, but also their sub-division into 2 types, thus

Anxiety levels at start of therapy was 65, which went down to 58 & then to 54.

My avoidance frequency went from 60 to 47 to 38, a whole -22 points, or -36.67% in comparison to pre-therapy! (I say pre, as I had only had a get-to-know first session and discussing the plan of work). 

As you can see, CBT for me, for social phobia, was rather successful and I exceeded my goal of reducing my avoidance by 25% ; although my overall anxiety is still there, with a moderate reduction of 16.9%, it still represents a good progress, as I've suffered with this phobia most of my life. 

To get these results, everything started with those lists of social situations that my first cbtherapist had requested but never helped me with ; these lists had the goal of identifying and specifying relative anxiety levels between different social situations, instead of nebulous feelings of stress in any situation.

My second CBtherapist asked me to organise those massive lists that had grown out of proportions, and redirected their work into exposures, usually with gradual increases in difficulty levels. 

On some occasions, such as 2 trips to Paris in Summer 2016, my exposures suddenly grew in difficulty, before their time - that is, before I'd naturally get to them in CBT.

Not having been fully prepared for those tougher exposures, I had experiences panic attacks and setbacks in learning my coping mechanisms, but they didn't stop my learning, in time. 

The most valuable things I learned in therapy are to be patient and to practice self love, self kindness, and to cut myself some slack, trying again if and when I fail at a task. It's okay to have occasional unpredictable exposures, as it keeps you alert and shows you the road you can take later on, once you are ready. 

CBT may not work for every single person, nor every single difficulty. It was proved rather successful in treating phobias, including my own social phobias but also other types ; But, as each person is unique, you may find other types of therapy more suitable, and that's okay, as long as you find the proper type AND proper therapist, you can learn to cope, to recover, and maybe even to heal. But, if your condition is tough and lasted most of your life, you may need extra patience and work ; you may only learn to better cope for a time, and that's fine, because it raises quality of life by helping you to better withstand the various stressful situations you meet in life, and to reduce overall anxiety, fear, and frequency of panic attacks. 

From now on, I will do my exposures to continually improve my coping skills, until I can reduce even the highest anxiety levels to more tolerable and manageable ones. 

My next session, in 2 weeks, will be my first for my complex-emetophobia, that which I have been discussing in quite a few posts, and which pertains to 4 phobias. I'll detail this in a new series of entries, with the label CBT4Emeto. 

If you want a full overview of my CBT sessions and exposures, here's a breakdown of links to my relevant entries, all under CBT2016, CBT2017 and Exposure Therapy (but which include also general entries, that I invite you to read if you want).

The more precise are for sessions and exposures between sessions, as follows : 

Session 1 (entry 76) was very short, announcing the new therapy
Session 2 (93)  was about the same length and discusses content only briefly 
S 3 (101) finally starts talking about exposures, including first trip to Paris (104)
S 4 (106) 
S 5 (117) including second trip to Paris (118)
S 6 (122)
S 7 (136)
S 8 (141) 
9th & 10th sessions in one entry (144) 
11th & 12th as well (150)
13th session closed 2016 (153)
14th session (162) , its exposure tasks (169) 
I had to split 15th session  (173)  with some extra advice that I felt needed its own entry (174) and exposures between the 15th & 16th  (178 & 179 & 180)

I felt the need to boost my exposures as I had experienced difficulties, and thus created a challenge that I had invited friends from twitter Mh community, and which I discussed in entries (182) (183) for the first 11 days, (188) up to day 26 and which is already after 16th CBT, (215) was meant as days 19 onward, but I had given up on the challenge shortly after (situated also after 17th CBT). 

16th session got one entry (187) 
17th (209),  with exposure in the park (222 & ) birthday party (223) 
18th (225) 
19th (237) and may exposures (245)
20th CBT session, June exposures and more (250)
21st is when I included specific dates of exposures in my titles in entry (260)
22nd session & exposures (265)
23rd & exposures (276) including a weekend of massive exposures (282)
24th & exposures (288)
25th & last exposures that I report to my therapist (298)

You'll notice that one of the purposes of numbering my entries was to have an easy back-referencing to each, and that between sessions, my entries vary either due to personal inspirations, or following challenges - which is why you may see 2 consecutive sessions and exposures with almost nothing in between and others, several or many more entries separate the topic.