Does CBT work? What other options are there?

L

Logan0492

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Joined
Nov 5, 2017
Messages
37
#1
Hi,

brief overview, I have been struggling with depression since 2008, I have been on a bunch of meds. Last year I was really struggling and decided to sign up for some therapy, I got 17 sessions of CBT from a therapist which I think helped me understand more about the depression, and how to try and deal with it. I do think that helped. But I kept thinking more of my troubles come from the past and that is what is making me feel depressed and we did touch upon this and we worked together and put a plan into place to try and put things in throughout the year to look forward to, which I have done.

However, around December, I had just a sudden wave of low mood, I was just picking up my cup of tea and it was like a switch had gone of in my head. I had finished with CBT for about 8-10 weeks at that point and was doing well, I was feeling more positive about things and then when that low mood came in I panicked. I tried to do the CBT stuff but it was not working, and I did not know what to do. I ended up at the gps and asked about CBT again. I reached out to the therapist I saw and I was put back on the list.

I was unable to see the same therapist this time, so it is someone different, I have seen her twice now, but doing some of the homework set has brought up memories that could possibly be effecting me somehow but I do not know why or how.

Also, I am not sure about this new therapist, she comes across as more stern and more serious


Should I ask her about what other options are other than CBT ?


Does anyone know what other options there are?

could it be that this therapist is not right for me? But could be great for someone else?
 
L

Logan0492

Active member
Joined
Nov 5, 2017
Messages
37
#2
why I am not sure about this therapist. for example, I am going out of the house, but it does take a lot of work to leave and I do get anxious about leaving the house. I am ok when I am out, and sometimes my mind drift and I do want to go home, but I focus on something around me, which my first therapist told me to do. I have also set different things to do each month that I do not do everyday, which me and my first therapist talked about . but this new one wants me to do something totally different. I am like, what? and when? I can not drive, so I have to rely on buses and some stop at certain times. I am not really interested in a lot of things and things I am interested in are too far to travel.
 
Bizzarebitrary

Bizzarebitrary

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Dec 17, 2018
Messages
410
Location
California, US
#3
First I want to say well done on completing CBT. I think it's praiseworthy for any of us suffering with mental illness to give a try at managing our symptoms with cognitive skills. I think of CBT as a toolbox of skills which we can use daily but I also think it's not meant to be the only help for us to rely on.
You also mentioned you learned about depression and how to deal with it which is so important as a foundation. For there to be an understanding that we are not our illness and to begin a journey towards recovery we must be capable of separating the "me" from the "we" (if that makes sense).

I was feeling more positive about things and then when that low mood came in I panicked. I tried to do the CBT stuff but it was not working, and I did not know what to do.
If I understand you, it sounds like you experienced a bit of a crisis and the skills just weren't helpful in that moment. I've had this happen before. Afterwards I asked my therapist whether it was my fault that I couldn't apply the CBT skills properly and/or did these skills actually work given how they seemed ineffective when I needed them the most?
The answer I got was "no" to both questions, rather it's a third question i didn't know to ask and that is, when are CBT skills most effective?

When we have an episode that shoots us to the top of the emotional wave (like panic or manic), we're probably not going to have success using cognitive therapy techniques because the part of our brain that processes those thoughts is already being sort of short-circuited. Broadly - and likely inaccurately - put, when we're in a crisis mode, our amygdala takes charge. We need the hippocampus in order to process more complex thoughts or reactions requiring deliberation.

CBT is therefore very useful for day-to-day self care/maintenance and greatly useful for managing emotions before they take us up the crest of that wave. Sometimes, it can interrupt an emotional snowball effect if we can apply the right skills in a timely way.

doing some of the homework set has brought up memories that could possibly be effecting me somehow but I do not know why or how.
Do you mean you're feeling uneasy from touching upon some memories of a past trauma?

Should I ask her about what other options are other than CBT ?
I couldn't and shouldn't say what direction your therapy ought to go, I feel that's best left to you and your therapist. Navigating one's mental health journey is so strictly personal and what happens along the way is so important and revealing.

Since I mentioned that CBT might not be useful during a crisis I ought to mention what I think is. Distress tolerance skills are very useful when we need to climb down from a mental health emergency. You could ask about that. DT skills are part of another cognitive therapy called DBT. I wrote up the beginning of an overview of DBT here in the 'talking therapies' forum if you're interested in reading about it.
 
Bizzarebitrary

Bizzarebitrary

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Messages
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#4
I have also set different things to do each month that I do not do everyday, which me and my first therapist talked about . but this new one wants me to do something totally different. I am like, what? and when?
Right. If I were to guess at what's being suggested here. Depression takes many things from us, among them is our sense of anything being possible for us. Adventures, growth and development. It's been shown to be effective treatment when this is overcome by exposure to new experiences as opposed to our inclination to make our world small, more manageable.

Putting oneself in situations where we aren't comfortable helps in several ways. For example, when we try something that's new and uncomfortable we struggle a bit but for the most part, we emerge realizing that this experience didn't destroy us, we are ok. This lends confidence to other significant steps we make along the way towards recovery. Trying new things also helps us build confidence, mastery, a sense that we're more capable than we realize because so much of our illness is about what we can't do. It also helps in building new neural pathways which are shown to be a significant component in recovery from depression.

Not all suggestions are useful and some you may not be ready for. You are the pilot of your own journey. The first significant step is in realizing that it's possible to do these things you may have believed were beyond your ability. Incremental steps build a sense of competence that's taken from us because anxiety is always telling us that the outcome will be dire.
 
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Logan0492

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Joined
Nov 5, 2017
Messages
37
#5
Right. If I were to guess at what's being suggested here. Depression takes many things from us, among them is our sense of anything being possible for us. Adventures, growth and development. It's been shown to be effective treatment when this is overcome by exposure to new experiences as opposed to our inclination to make our world small, more manageable.

Putting oneself in situations where we aren't comfortable helps in several ways. For example, when we try something that's new and uncomfortable we struggle a bit but for the most part, we emerge realizing that this experience didn't destroy us, we are ok. This lends confidence to other significant steps we make along the way towards recovery. Trying new things also helps us build confidence, mastery, a sense that we're more capable than we realize because so much of our illness is about what we can't do. It also helps in building new neural pathways which are shown to be a significant component in recovery from depression.

Not all suggestions are useful and some you may not be ready for. You are the pilot of your own journey. The first significant step is in realizing that it's possible to do these things you may have believed were beyond your ability. Incremental steps build a sense of competence that's taken from us because anxiety is always telling us that the outcome will be dire.
Thank you for getting back to me.

I did tell her that I try and go for a walk each day. However, I did not tell her that it takes quite abit of effort to go, especially when I am on my own. I will put it off or be restless and just walk around the house abit etc. Some days are easier than others though.

I haven’t got many friends. I have 1 friend really and then my brother. So past two nights when my brother has been going to see his friends at the pub I have joined him. It has caused some anxiety issues however, I am also going to London this weekend with my friend and I am anxious about that as well.

I know my therapist wants me to do new things. My first therapist told me to do that as well, which I have tried to keep up by trying to do something different each month even if its just 1 night like go and see a film or holiday.

Think the next few weeks are going to be interesting as I am going to london this week, in april going to see a gig and go to the cinema and may going on holiday for a week, plus can go to the pub with my friend or/and with my brother and his friends. Plus CBT.
 
L

Logan0492

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Joined
Nov 5, 2017
Messages
37
#6
First I want to say well done on completing CBT. I think it's praiseworthy for any of us suffering with mental illness to give a try at managing our symptoms with cognitive skills. I think of CBT as a toolbox of skills which we can use daily but I also think it's not meant to be the only help for us to rely on.
You also mentioned you learned about depression and how to deal with it which is so important as a foundation. For there to be an understanding that we are not our illness and to begin a journey towards recovery we must be capable of separating the "me" from the "we" (if that makes sense).


If I understand you, it sounds like you experienced a bit of a crisis and the skills just weren't helpful in that moment. I've had this happen before. Afterwards I asked my therapist whether it was my fault that I couldn't apply the CBT skills properly and/or did these skills actually work given how they seemed ineffective when I needed them the most?
The answer I got was "no" to both questions, rather it's a third question i didn't know to ask and that is, when are CBT skills most effective?

When we have an episode that shoots us to the top of the emotional wave (like panic or manic), we're probably not going to have success using cognitive therapy techniques because the part of our brain that processes those thoughts is already being sort of short-circuited. Broadly - and likely inaccurately - put, when we're in a crisis mode, our amygdala takes charge. We need the hippocampus in order to process more complex thoughts or reactions requiring deliberation.

CBT is therefore very useful for day-to-day self care/maintenance and greatly useful for managing emotions before they take us up the crest of that wave. Sometimes, it can interrupt an emotional snowball effect if we can apply the right skills in a timely way.


Do you mean you're feeling uneasy from touching upon some memories of a past trauma?


I couldn't and shouldn't say what direction your therapy ought to go, I feel that's best left to you and your therapist. Navigating one's mental health journey is so strictly personal and what happens along the way is so important and revealing.

Since I mentioned that CBT might not be useful during a crisis I ought to mention what I think is. Distress tolerance skills are very useful when we need to climb down from a mental health emergency. You could ask about that. DT skills are part of another cognitive therapy called DBT. I wrote up the beginning of an overview of DBT here in the 'talking therapies' forum if you're interested in reading about it.
Thank you for replying to me

I have wrote a couple of things down to ask me therapist.

I think what happened was a number of things from the last session. I was not feeling very well, a lot of information was provided, Monday morning, then just how she came across waa more stern compared with my first therapist.

We are looking at behaviours and core beliefs, I have some memories that can support a belief but I do not know what that belief is.

I have got a busy couple of months coming up that probably will cause some anxiety for me. Like I am going to London with a friend and at the moment I do not want to go. Eventhough it was me who asked. Same with smaller things like cinema or something like that, a few days before i start to think I don’t want to go.
 
Bizzarebitrary

Bizzarebitrary

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Messages
410
Location
California, US
#7
I did tell her that I try and go for a walk each day. However, I did not tell her that it takes quite abit of effort to go, especially when I am on my own. I will put it off or be restless and just walk around the house abit etc. Some days are easier than others though.
This is good work. Also, trying a new thing each month is really good work, you're doing pretty well! It's okay if some days you cannot manage it, there are days I cannot manage and accepting that reality is much better than to chastise oneself or feel worse for not being able. For depression, I feel that self-compassion is an integral part of recovery which entails accepting that some days, we are not the best version of ourselves. Does this make sense to you?

For walking outside I'd like to share some things that helped motivate me and also helped regulate my anxiety. I find that listening to music through earphones helps me self-sooth and distract me from anxious, intrusive thoughts. Music diverts my attention from the din of traffic, the people passing by, signs and flashing lights - things that increase my anxiety. I doubt I'd have been successful without it. What to listen to is entirely up to your tastes, happy so supply suggestions. Also, it doesn't have to be music it could be an audio book or podcast.

When I go out for walks I always have a destination in mind, usually a place where I can sit and have a tea or coffee maybe something to eat. It is meant to be a reward.

It appears you have a lot going on next week. London, a show, a vacation too? How are you feeling about it all? I'm a little anxious about my vacation in April I'll be in Paris and London, for portions with my brother and his wife but for the greater part of 3 weeks, I'll be alone so that ought to be interesting. It'll certainly test my ability to cope with new situations and my hope is to come away feeling more confident. If you have any advice to give me I'd be glad of it.

We are looking at behaviours and core beliefs, I have some memories that can support a belief but I do not know what that belief is.
This is good work here, challenging negative core beliefs is important, they hold us back and become food for depression. It can be difficult if we're not ready to be totalky honest with the therapist we're working with.

It sounds like you're uncertain about the new therapist. Perhaps she may not have built trust or even a rapport with you. You mention her seeming stern. You might challenge that impression during your next session and ask yourself, "Is that stern or professional detachment?" Its okay to use some of your together to get to know one another, even ask her questions like, why she became a therapist, does she see a lot of patients who have depression - loosten up the rigidity of the session. If she inquires what you're on about with these questions, you can say it helps you to open up, to trust someone else after you know a little about them.

After that, if you still feel there's no connection, you can advocate for yourself by requesting a different therapist. The worst that can happen is they tell you there's no one else available.

I'd like to finish this rather long reply by restating that I think you're doing real well with your treatment, this is not easy work - let no one tell you it is.
Please have patience with the process and with yourself. This does get easier but sadly, no shortcuts and fast-forward button to get past the awkward and dreadful bits.
 
L

Logan0492

Active member
Joined
Nov 5, 2017
Messages
37
#8
This is good work. Also, trying a new thing each month is really good work, you're doing pretty well! It's okay if some days you cannot manage it, there are days I cannot manage and accepting that reality is much better than to chastise oneself or feel worse for not being able. For depression, I feel that self-compassion is an integral part of recovery which entails accepting that some days, we are not the best version of ourselves. Does this make sense to you?

For walking outside I'd like to share some things that helped motivate me and also helped regulate my anxiety. I find that listening to music through earphones helps me self-sooth and distract me from anxious, intrusive thoughts. Music diverts my attention from the din of traffic, the people passing by, signs and flashing lights - things that increase my anxiety. I doubt I'd have been successful without it. What to listen to is entirely up to your tastes, happy so supply suggestions. Also, it doesn't have to be music it could be an audio book or podcast.

When I go out for walks I always have a destination in mind, usually a place where I can sit and have a tea or coffee maybe something to eat. It is meant to be a reward.

It appears you have a lot going on next week. London, a show, a vacation too? How are you feeling about it all? I'm a little anxious about my vacation in April I'll be in Paris and London, for portions with my brother and his wife but for the greater part of 3 weeks, I'll be alone so that ought to be interesting. It'll certainly test my ability to cope with new situations and my hope is to come away feeling more confident. If you have any advice to give me I'd be glad of it.


This is good work here, challenging negative core beliefs is important, they hold us back and become food for depression. It can be difficult if we're not ready to be totalky honest with the therapist we're working with.

It sounds like you're uncertain about the new therapist. Perhaps she may not have built trust or even a rapport with you. You mention her seeming stern. You might challenge that impression during your next session and ask yourself, "Is that stern or professional detachment?" Its okay to use some of your together to get to know one another, even ask her questions like, why she became a therapist, does she see a lot of patients who have depression - loosten up the rigidity of the session. If she inquires what you're on about with these questions, you can say it helps you to open up, to trust someone else after you know a little about them.

After that, if you still feel there's no connection, you can advocate for yourself by requesting a different therapist. The worst that can happen is they tell you there's no one else available.

I'd like to finish this rather long reply by restating that I think you're doing real well with your treatment, this is not easy work - let no one tell you it is.
Please have patience with the process and with yourself. This does get easier but sadly, no shortcuts and fast-forward button to get past the awkward and dreadful bits.
Thank you for the reply

I am anxious about going to London with my friend. Just pretty much all of it I am anxious about.

When I go for a walk I tend to play Pokemon go and listen to music. Just the build up to go.

I think what did me in the session was I was feeling ill and a lot of information was said to me.
 
L

Logan0492

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Joined
Nov 5, 2017
Messages
37
#9
This is good work. Also, trying a new thing each month is really good work, you're doing pretty well! It's okay if some days you cannot manage it, there are days I cannot manage and accepting that reality is much better than to chastise oneself or feel worse for not being able. For depression, I feel that self-compassion is an integral part of recovery which entails accepting that some days, we are not the best version of ourselves. Does this make sense to you?

For walking outside I'd like to share some things that helped motivate me and also helped regulate my anxiety. I find that listening to music through earphones helps me self-sooth and distract me from anxious, intrusive thoughts. Music diverts my attention from the din of traffic, the people passing by, signs and flashing lights - things that increase my anxiety. I doubt I'd have been successful without it. What to listen to is entirely up to your tastes, happy so supply suggestions. Also, it doesn't have to be music it could be an audio book or podcast.

When I go out for walks I always have a destination in mind, usually a place where I can sit and have a tea or coffee maybe something to eat. It is meant to be a reward.

It appears you have a lot going on next week. London, a show, a vacation too? How are you feeling about it all? I'm a little anxious about my vacation in April I'll be in Paris and London, for portions with my brother and his wife but for the greater part of 3 weeks, I'll be alone so that ought to be interesting. It'll certainly test my ability to cope with new situations and my hope is to come away feeling more confident. If you have any advice to give me I'd be glad of it.


This is good work here, challenging negative core beliefs is important, they hold us back and become food for depression. It can be difficult if we're not ready to be totalky honest with the therapist we're working with.

It sounds like you're uncertain about the new therapist. Perhaps she may not have built trust or even a rapport with you. You mention her seeming stern. You might challenge that impression during your next session and ask yourself, "Is that stern or professional detachment?" Its okay to use some of your together to get to know one another, even ask her questions like, why she became a therapist, does she see a lot of patients who have depression - loosten up the rigidity of the session. If she inquires what you're on about with these questions, you can say it helps you to open up, to trust someone else after you know a little about them.

After that, if you still feel there's no connection, you can advocate for yourself by requesting a different therapist. The worst that can happen is they tell you there's no one else available.

I'd like to finish this rather long reply by restating that I think you're doing real well with your treatment, this is not easy work - let no one tell you it is.
Please have patience with the process and with yourself. This does get easier but sadly, no shortcuts and fast-forward button to get past the awkward and dreadful bits.
i had my third session of cbt yesterday.
i went in more engaging and feeling a little more positive to tell her how I had been and what i had been doing that improved my mood.
sort of feel like that was just dismissed, I went to london that was out of my comfort zone and I got an understanding of the more I do out of my comfort zone the easier things will get to do but hardly talked about it.
I feel like I have been pressured/bullied into doing this job course.
I would like to do it, but not at the moment as I am going away towards the end of the month, then again in mid MAY and again in early JUNE. ALL for a week and I feel that they would not appreciate doing a week missing a week doing 2 weeks missing a week etc.
I feel because of this it has made me depressed again as well as anxious.
I KNOW SHE WANTS ME TO FEEL ANXIOUS AND DO THINGS OUT OF MY COMFORT ZONE TO FIND A REASON BEHIND SOME OF IT. BUT most of the time it is just a feeling in my stomach.
I probably am anxious about this course because after I left school I went to college then did another 2 terms somewhere else. But quit, due to the course changing. I struggled to find work over the years, I got a few zero hour contracts but was never used or trained. Did some volunteer work last year. The other thing was that I had been unwell as well.-2013 ish I had a constant headache for like 6 months, some days I could not get out of bed because it was that bad. saw the gp but could not find anything. 2017-2018 I had something wrong with my stomach that affected me for around 6-8months. I could not bend without being in pain, somedays I could not eat without vomiting . Plus throughout that depression and anxiety. I KNOW WHEN I HAD MY FIRST ANXIETY ATTACK IT TOOK ME over a year to get back to some normality.

I did make my own business on ebay selling anything, but mainly toys. WHICH I AM STILL DOING, recently I have just completed a cleaning course in which I got a distinction in.
 
H

Holl

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Messages
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Location
England
#10
I’m sorry to hear you are struggling! I went to a therapist for a few months who originally tried CBT which didn’t seem to work so instead we tried DBT (dialectical behavioural therapy) which was originally meant for people with BPD but I found the focus on emotions helped a lot more and it sounds like you are struggling with the ‘waves’ of depression which DBT really focuses on. There are some useful workbooks on Amazon for it.
Hope you find this useful!

Holl
 
L

Logan0492

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Joined
Nov 5, 2017
Messages
37
#11
I’m sorry to hear you are struggling! I went to a therapist for a few months who originally tried CBT which didn’t seem to work so instead we tried DBT (dialectical behavioural therapy) which was originally meant for people with BPD but I found the focus on emotions helped a lot more and it sounds like you are struggling with the ‘waves’ of depression which DBT really focuses on. There are some useful workbooks on Amazon for it.
Hope you find this useful!

Holl
I was doing ok before Monday and tell her what has happened to improve my mood, but I felt it was just dismissed.

Along with that and feeling like I was bullied into a course, I feel like I am in a worse place.
 
H

Holl

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England
#12
I’m sorry you felt dismissed, it’s hard when someone doesn’t seem to understand how hard life is and how much effort it takes to do the steps you’re taught.

I would highly recommend this workbooklet: https://www.amazon.co.uk/Dialectica...75&hvtargid=pla-437102392715&psc=1&th=1&psc=1

It will provide you with a lot of techniques you can use in daily situations to distract from your anxiety and even though it’s not speaking to someone it feels like the author really understands how hard overwhelming emotions can be.

Holl
 
L

Logan0492

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Messages
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#13
I’m sorry you felt dismissed, it’s hard when someone doesn’t seem to understand how hard life is and how much effort it takes to do the steps you’re taught.

I would highly recommend this workbooklet: https://www.amazon.co.uk/Dialectica...75&hvtargid=pla-437102392715&psc=1&th=1&psc=1

It will provide you with a lot of techniques you can use in daily situations to distract from your anxiety and even though it’s not speaking to someone it feels like the author really understands how hard overwhelming emotions can be.

Holl
Thank you

Ill read a little more into it.

Its frustrating that I feel I made progress just for it not to really count then sort of be bullied into doing something that Id like to but do it in the future.
 
G

gam9147

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Delaware, USA
#14
Hi, sorry I'm getting to this thread a bit late, but just to weigh in. My primary is anxiety not depression, but there are many overlaps of course.

I did a lot of CBT in the past and my new therapist has me working on dialetic based (DBT). I recommend both, there is quite a bit of overlap but the approach is different and it may help more. So yes there are many types of therapies.

As to your new therapist being a good fit -- I'm struggling with that too. Its hard to know at first, but know a few things. Firstly -- therapy does make you feel a lot worse many times before you feel better. I still get anxious around my therapy sessions just because I know we may bring up something that will make me more anxious for days, or even weeks. That's good in the long run, bad in the short run.

But therapists are like significant others -- you have to be comfortable and trust them. If you don't then it really doesn't matter how good they are, you could possibly benefit from a different one. But of course money, time, distance play a role. From the sound of things objectively it doesn't seem your therapist is 'bad' for you, maybe just pushing a little more.

What I do know from experience is sometimes that push is needed and good, but many times as you are feeling it feels like too much. You won't get better in a linear fashion, you will have days that go up and down, and whole periods that are remission. i have recently as well.

But putting yourself in situations where you will likely feel anxious and sad, and learning techniques to combat those situations is the whole point of therapy and getting better. Its absolutely hard and terrifying and you should defintely take it slowly at your own pace, but it is the right path.

I hope that helps!
 
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LouiseMN

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#15
I need a therapist. I am in awe of all of you. Thanks for the info on therapy.
 
A

Ambivalence

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The Philippines
#16
Some other therapies or interventions I’ve tried.

1. Mindfulness meditation
2. Shadow work
3. Archetype therapy
4. Inner child work
5. Journal prompts
6. Creative writing
7. Volunteering
8. Strength exercise
9. Running
10. Yoga
11. Grounding techniques
12. Bibliotherapy or reading
13. Reflecting on quotes
14. Support groups
15. Mental health apps
16. Watching thoughtprovoking films
17. Comedy
18. Distracting myself with board games.
19. Supporting click to donate sites
20. Supporting petition sites like Change.org, Care2 and Global Citizen.
21. Learning about personality from Personality Junkie and Personality Hacker
22. Enneagram
23. Attachment styles
24. Venting on live chats in 7 cups of tea
25. Having historical role models
 
A

Ambivalence

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#17
Just wanted to explain my situation a bit. I’m not the type to feel like doing nothing when I’m stressed to be honest. I tend to be outwardly calm, but inwardly hot tempered, especially after being hurt in the past. Doing a lot of things while trying not to overwork to the point of an asthma attack is usually how I do things. Hopefully I figure out how to calm down more sometimes.
 
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Logan0492

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Messages
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#18
So week 3 I felt bullied into seeing a job advisor. I do not want to see a job advisor. I am going away for roughly 5 weeks in 2 weeks and then end of July I am going to go with my brother traveling around the uk for a number of weeks.
 

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