global_id,video_id,turn_id,reference_label,patient_transcript,context,start_time_sec,end_time_sec
001_001,001,1,2,"Yeah, I thought I should I've been feeling quite bad for quite a while. So I thought maybe it's time to see someone about it because I don't want to feel like this anymore.","Therapist: ""Hi Lucy, nice to meet you. Hi. So I understand that you were referred here by your GP because you've been feeling quite down recently.""",28.03,37.34
001_005,001,5,4,"Quite a few months before that as well, actually. But it's gotten pretty bad these past few months. So that's kind of why I came.","Therapist: ""Okay. So from your notes, I saw that you saw the GP about three months ago.""
Patient: ""Yeah.""
Therapist: ""So how long have you been feeling down altogether?""",47.47,55.52
001_007,001,7,2,"Well, it kind of started just feeling a bit low and wound up about things, but I don't know, just recently, I just can't really be bothered to do anything at all. I kind of find it hard to get motivated for things and I want to be, I really want to be better, but it's just kind of reaching the end now where I just, I want to do something about it.","Therapist: ""So how long have you been feeling down altogether?""
Patient: ""Quite a few months before that as well, actually. But it's gotten pretty bad these past few months. So that's kind of why I came.""
Therapist: ""Okay. So has it got worse since you saw your GP? Yeah. Okay. So tell me, how are things at the moment?""",65.3,88.42
001_009,001,9,2,"I don't like to think about it, but I just know.","Therapist: ""Okay. So has it got worse since you saw your GP? Yeah. Okay. So tell me, how are things at the moment?""
Patient: ""Well, it kind of started just feeling a bit low and wound up about things, but I don't know, just recently, I just can't really be bothered to do anything at all. I kind of find it hard to get motivated for things and I want to be, I really want to be better, but it's just kind of reaching the end now where I just, I want to do something about it.""
Therapist: ""okay so you said that you're feeling really down really sad yeah and you feel like you haven't got any motivation um but are you okay yeah i'm fine sorry okay um and you haven't got any motivation but it sounds like you're putting quite a lot of pressure on yourself to try and feel a bit better yeah i just it's kind of hard as well because there's not really anyone to talk about so i just kind of stay on my own trying to""",118.42,122.71
001_011,001,11,4,"Yeah, there's no one I can talk to about it. No one would listen or understand anyway.","Therapist: ""okay so you said that you're feeling really down really sad yeah and you feel like you haven't got any motivation um but are you okay yeah i'm fine sorry okay um and you haven't got any motivation but it sounds like you're putting quite a lot of pressure on yourself to try and feel a bit better yeah i just it's kind of hard as well because there's not really anyone to talk about so i just kind of stay on my own trying to""
Patient: ""I don't like to think about it, but I just know.""
Therapist: ""Okay. So you say you've been, you're feeling quite isolated. There's not many people around.""",126.7,131.17
001_014,001,14,4,"Yeah, I mean they're lovely, I get on really well with them but I don't know. Recently, whenever they want to go out or stuff, I don't want to bring them down. They don't understand what I'm going through. They don't make fun of how I feel, but they don't really understand what it's like. I don't want to go out with them and bring them down or stuff.","Patient: ""Yeah, there's no one I can talk to about it. No one would listen or understand anyway.""
Therapist: ""Okay, so I'm just going to try and find out a little bit more about you. So I understand that you're an English student at uni?""
Therapist: ""And you live away from home with some friends, is that right? Yeah, I live here. Okay, so you don't live far from the uni, but you say you feel like you live with your friends but you don't feel like you can talk to them.""",151.85,175.61
001_016,001,16,4,"I guess. I mean, it's easier to hide it than to try and explain it all the time when no one really wants to know.","Therapist: ""And you live away from home with some friends, is that right? Yeah, I live here. Okay, so you don't live far from the uni, but you say you feel like you live with your friends but you don't feel like you can talk to them.""
Patient: ""Yeah, I mean they're lovely, I get on really well with them but I don't know. Recently, whenever they want to go out or stuff, I don't want to bring them down. They don't understand what I'm going through. They don't make fun of how I feel, but they don't really understand what it's like. I don't want to go out with them and bring them down or stuff.""
Therapist: ""Okay. So it sounds, do you try and hide the way you're feeling from them?""",180.24,187.38
001_018,001,18,2,"No, I don't really talk to my parents a lot either, so that's kind of hard.","Therapist: ""Okay. So it sounds, do you try and hide the way you're feeling from them?""
Patient: ""I guess. I mean, it's easier to hide it than to try and explain it all the time when no one really wants to know.""
Therapist: ""Okay, so it sounds like you've been feeling down, you've been feeling unmotivated, you feel like you want to be better, but actually it sounds like you feel like you can't reach out for help, you can't speak to anybody.""",200.24,206.23
001_020,001,20,2,Yeah. I guess it kind of started when I was actually when I was revising for my exams I guess the stress I put a lot of stress on myself I think I've always wanted to do well for me and I guess for my parents so the stress of exams and it was also kind of hard because my parents were going through a bit of a troubled time then so okay so this would be like last March last April yeah,"Therapist: ""Okay, so it sounds like you've been feeling down, you've been feeling unmotivated, you feel like you want to be better, but actually it sounds like you feel like you can't reach out for help, you can't speak to anybody.""
Patient: ""No, I don't really talk to my parents a lot either, so that's kind of hard.""
Therapist: ""Okay, I'm just going to go back in time a little bit. I suppose I'm just wondering, when did all of this start? You said it's been going on for quite a few months.""",213.47,247.33
001_022,001,22,5,"Yeah, I guess it was hard as well because I wasn't doing well at uni and I guess I just felt a bit guilty. I know it sounds silly but I felt like maybe if I could do better then they would get better but it just wasn't really happening.","Therapist: ""Okay, I'm just going to go back in time a little bit. I suppose I'm just wondering, when did all of this start? You said it's been going on for quite a few months.""
Patient: ""Yeah. I guess it kind of started when I was actually when I was revising for my exams I guess the stress I put a lot of stress on myself I think I've always wanted to do well for me and I guess for my parents so the stress of exams and it was also kind of hard because my parents were going through a bit of a troubled time then so okay so this would be like last March last April yeah""
Therapist: ""I think so. Around that time, so about six months-ish. And it sounds like a lot was happening. So you had a lot of uni pressure on and you said that your parents were having marital problems? Yes. Okay. And it sounds like that was a real shock to you.""",267.55,284.56
001_024,001,24,2,"Yeah, I wanted to make them feel better but It just kind of backfired a little, I guess.","Therapist: ""I think so. Around that time, so about six months-ish. And it sounds like a lot was happening. So you had a lot of uni pressure on and you said that your parents were having marital problems? Yes. Okay. And it sounds like that was a real shock to you.""
Patient: ""Yeah, I guess it was hard as well because I wasn't doing well at uni and I guess I just felt a bit guilty. I know it sounds silly but I felt like maybe if I could do better then they would get better but it just wasn't really happening.""
Therapist: ""Okay, so it sounds like you were trying to work hard and be more successful because you thought that that would make them happier and try and fix things.""",294.09,299.42
001_026,001,26,2,It just ended up with them getting worse and I've just been feeling worse since then.,"Therapist: ""Okay, so it sounds like you were trying to work hard and be more successful because you thought that that would make them happier and try and fix things.""
Patient: ""Yeah, I wanted to make them feel better but It just kind of backfired a little, I guess.""
Therapist: ""How did it backfire?""",302.7,307.63
001_028,001,28,4,It's just annoying because I know I should have done better and I just didn't and I guess I beat myself up a lot about it.,"Therapist: ""How did it backfire?""
Patient: ""It just ended up with them getting worse and I've just been feeling worse since then.""
Therapist: ""Okay, so after the summer, after the exam period, and how did that exam period go for you in the end? Not very well. Okay, that's an awful lot of pressure to put on yourself.""",320.76,332.03
001_030,001,30,4,"Probably, maybe more than other people. My parents have always kind of taught me, not in a loving way, I guess, but that you should do your best, but also get the best. I agree with that. I think that's the right thing to think. But when I don't do that, I don't know, it annoys me a lot and I worry that it annoys them.","Therapist: ""Okay, so after the summer, after the exam period, and how did that exam period go for you in the end? Not very well. Okay, that's an awful lot of pressure to put on yourself.""
Patient: ""It's just annoying because I know I should have done better and I just didn't and I guess I beat myself up a lot about it.""
Therapist: ""So you say, I know I should have done better. I mean, I suppose hearing it from my perspective, I'm thinking it sounds like you had an awful lot going on at the time. It would be understandable, absolutely, that you wouldn't do as well as normal. I suppose I'm just wondering if you have very high standards for yourself.""",351.57,375.94
001_034,001,34,2,"I think it doesn't sound good. I don't really talk to them a lot, but I don't think they're going through very good things. I don't like to talk to them about it because it just makes me feel worse. But I don't think it's getting any better.","Therapist: ""So it sounds like you feel you should always do your best. Is that the word you used? Yeah. And that there isn't any kind of exceptions for that.""
Patient: ""No.""
Therapist: ""Okay. So I can see then that that was a really difficult time for you and that was when your mood started to get lower and things are still quite bad now. I mean, what's the situation with your parents at the moment?""",400.01,417.33
001_036,001,36,2,"For a little bit, yeah. And how was that? Not very fun, no. It was quite tense all the time. stressed me out more than relaxed me over the summer, I guess.","Therapist: ""Okay. So I can see then that that was a really difficult time for you and that was when your mood started to get lower and things are still quite bad now. I mean, what's the situation with your parents at the moment?""
Patient: ""I think it doesn't sound good. I don't really talk to them a lot, but I don't think they're going through very good things. I don't like to talk to them about it because it just makes me feel worse. But I don't think it's getting any better.""
Therapist: ""Were you home over the summer?""",419.41,435.12
001_038,001,38,4,"Really not good, to be honest. I actually... If I don't have to, then I don't really leave the house or get out of bed. I can't find the motivation for the things I used to enjoy. I used to love doing sports or going out and now I just prefer to lie in bed and not really do anything. I missed a few lectures this week that I should have gone to.","Therapist: ""Were you home over the summer?""
Patient: ""For a little bit, yeah. And how was that? Not very fun, no. It was quite tense all the time. stressed me out more than relaxed me over the summer, I guess.""
Therapist: ""Okay. Okay, so it sounds like quite a lot has been happening. You've been feeling very low. You've had uni pressure on. You've had problems with your parents' marriage. And it sounds like you feel like you can't really reach out to anyone, that you can't understand, but you can't really reach out to your parents right now. You can't really confide in your friends. So I suppose I'm just wondering if you can tell me a bit more about how you've been feeling, I mean, say this past week.""",463.01,486.21
001_040,001,40,5,"I don't really see the point anymore. If I can't do as well as I should be doing, then what's the point in putting myself in those positions? I just, I can't be bothered anymore to try. It just stresses me out more than I need to.","Therapist: ""Okay. Okay, so it sounds like quite a lot has been happening. You've been feeling very low. You've had uni pressure on. You've had problems with your parents' marriage. And it sounds like you feel like you can't really reach out to anyone, that you can't understand, but you can't really reach out to your parents right now. You can't really confide in your friends. So I suppose I'm just wondering if you can tell me a bit more about how you've been feeling, I mean, say this past week.""
Patient: ""Really not good, to be honest. I actually... If I don't have to, then I don't really leave the house or get out of bed. I can't find the motivation for the things I used to enjoy. I used to love doing sports or going out and now I just prefer to lie in bed and not really do anything. I missed a few lectures this week that I should have gone to.""
Therapist: ""Right, so I suppose I'm just wondering then, let's see if we can think about one thing, say a lecture. What kind of thoughts do you have about going to that lecture before it happens?""",499.91,518.54
001_043,001,43,4,"I feel like, I don't know, I don't really even deserve to be here if I can't do well enough. I feel these other students are doing well and doing better and want to be there. I don't know why I'm here even at uni to be honest.","Patient: ""I don't really see the point anymore. If I can't do as well as I should be doing, then what's the point in putting myself in those positions? I just, I can't be bothered anymore to try. It just stresses me out more than I need to.""
Therapist: ""Okay, so it sounds like the kind of thoughts you've got in your head are, it's pointless, it's not worth it.""
Therapist: ""Do you have any other thoughts in your head when you're just at that point before you go to the lecture?""",531.59,552.4
001_046,001,46,2,"Very unworthy probably would be the best way to put it, kind of. I don't know.","Patient: ""I feel like, I don't know, I don't really even deserve to be here if I can't do well enough. I feel these other students are doing well and doing better and want to be there. I don't know why I'm here even at uni to be honest.""
Therapist: ""So it sounds like you feel like you're not as good as other people here?""
Therapist: ""Okay, I'm just sorry is it okay if I take notes as we go through? It's just I'm trying to I guess understand what you're telling me and it helps me just to write it down and I'll share this with you later. Okay, so it sounds like those are some quite negative thoughts to have. You're kind of saying, you know, it feels like it's pointless, it's more effort than it's worth, and I don't deserve to be here. I mean, when you have those thoughts, how do you feel?""",582.42,593.36
001_048,001,48,2,"Sad. Not happiness. No, sad. A bit of kind of anger and frustration as well.","Therapist: ""Okay, I'm just sorry is it okay if I take notes as we go through? It's just I'm trying to I guess understand what you're telling me and it helps me just to write it down and I'll share this with you later. Okay, so it sounds like those are some quite negative thoughts to have. You're kind of saying, you know, it feels like it's pointless, it's more effort than it's worth, and I don't deserve to be here. I mean, when you have those thoughts, how do you feel?""
Patient: ""Very unworthy probably would be the best way to put it, kind of. I don't know.""
Therapist: ""lower than normal because then it makes me think about all the things that I should have been doing better okay so what you described that and you said I'm unworthy I should be doing lots of things better um those are kind of what I would call thoughts actually I suppose I'm trying to understand what it feels like in your gut what kind of emotions do you feel happier do you feel sad do you what kind of emotions are you feeling when you have those thoughts""",624.05,632.12
001_050,001,50,2,"embarrassed, but I've never yet talked about it so it's quite uncomfortable to be in this situation.","Therapist: ""lower than normal because then it makes me think about all the things that I should have been doing better okay so what you described that and you said I'm unworthy I should be doing lots of things better um those are kind of what I would call thoughts actually I suppose I'm trying to understand what it feels like in your gut what kind of emotions do you feel happier do you feel sad do you what kind of emotions are you feeling when you have those thoughts""
Patient: ""Sad. Not happiness. No, sad. A bit of kind of anger and frustration as well.""
Therapist: ""Okay. I notice when you're kind of telling me this, and I know this is quite a heavy topic, but you're kind of laughing and I suppose I wonder a little bit, are you a bit, you know, how do you feel about having these emotions, talking about these emotions?""",651.99,660.34
001_052,001,52,4,"I used to be, I think from those emotions, very wound up, very kind of stressed all the time. But recently it's just been a lot more draining than anything. Just quite lethargic and can't be bothered anymore and it's my body reflects that but then when i try and sleep i just can't seem to have a satisfied night's sleep it's really really frustrating so it sounds like this is affecting you it's draining you of your energy like like your body can't be bothered i think that's a really good way of describing it and you're noticing sleep problems as well and then","Therapist: ""Okay. I notice when you're kind of telling me this, and I know this is quite a heavy topic, but you're kind of laughing and I suppose I wonder a little bit, are you a bit, you know, how do you feel about having these emotions, talking about these emotions?""
Patient: ""embarrassed, but I've never yet talked about it so it's quite uncomfortable to be in this situation.""
Therapist: ""Okay, well you're doing a great job because I know that this can be difficult. Okay, so it sounds like some of the thoughts you're describing are, it's pointless, it's more than it's worth, I don't deserve to be here, I'm unworthy, and those kind of thoughts, it sounds like they just flip through your mind. And then you're kind of describing different emotions that those lead to. You're kind of describing sad, anger, frustration, embarrassed. What about in your body? What happens? How do you feel kind of physically?""",692.12,730.4
001_056,001,56,2,"I guess I feel slightly worse but then a bit numb in a way. Once you've felt that, because I do feel tired all the time, I just try and push it out and then you don't really think about anything and it's almost nicer that way than to keep focusing on how much you're getting wrong and how much you can't do stuff. Sometimes it's better just to not think about it at all.","Therapist: ""what do you do so this is so we're back to the point before the lecture so you start having these thoughts these emotions and you know your body i guess it sounds like those thoughts quite draining so we're draining your energy what then happens what do you do next um i kind of focus on the negative thoughts when i probably should not think about them but i focus on them and then i don't really want to do anything kind of stay in bed or So you think even more about those kind of worries that you have. So you do a bit of dwelling and you stay in bed. And it sounds like you don't, you haven't tried speaking to your friends about it.""
Patient: ""No.""
Therapist: ""Or speaking to family. Okay. And then after you've done that, so after you've not gone to the lecture, you've stayed in bed, you kind of spent time, as you said, focusing on those thoughts, those negative thoughts. How do you feel after that? Do you feel better or do you feel worse?""",788.83,817.16
002_001,002,1,2,"Yeah. I guess it kind of started like five, six years ago. Okay. It kind of escalated a bit. I've just recently moved out from living with my parents, so it's made it a bit worse, I think. Okay, is this the first time that you've left home? Yeah, it is the first time actually, yeah. I was going to a few years ago, I just thought it would be easier to stay at home.","Therapist: ""Hi, Hannah. Nice to meet you. Hi. So I understand that you were referred to me by your GP because you've been experiencing some anxiety difficulties. Yeah.""",29.41,55.06
002_004,002,4,2,"I haven't really told anyone, so it's made it better in the sense that I feel hopefully this is it, it'll help. But I don't know, I don't like thinking that I've had to do this. I never thought I'd be the kind of person who'd have to actually go and get help, if that makes sense.","Patient: ""Yeah. I guess it kind of started like five, six years ago. Okay. It kind of escalated a bit. I've just recently moved out from living with my parents, so it's made it a bit worse, I think. Okay, is this the first time that you've left home? Yeah, it is the first time actually, yeah. I was going to a few years ago, I just thought it would be easier to stay at home.""
Therapist: ""Okay, so it's been quite a big step and a big change and it sounds like that was what led you to go to your GP.""
Therapist: ""So how has that changed things for you?""",65.28,86.62
002_006,002,6,2,I thought that they'd be better but because I thought I'd have to kind of be independent and space actually a lot worse I'm I'm just kind of staying in the house a lot I don't really have any friends or anything I mean my family come and visit a bit but it's not I don't know it's kind of scary because I've just been kind of literally just in the flat by myself which I always thought I'd like but I don't actually like it,"Therapist: ""So how has that changed things for you?""
Patient: ""I haven't really told anyone, so it's made it better in the sense that I feel hopefully this is it, it'll help. But I don't know, I don't like thinking that I've had to do this. I never thought I'd be the kind of person who'd have to actually go and get help, if that makes sense.""
Therapist: ""Okay, so how do you feel about being here today? A bit scared, I don't know, hopefully it will help. Okay, so you've been feeling a little bit anxious about today? Yeah. Okay, so I guess just going back to why you went to the GP and how you've ended up coming here today. So it sounds like you've been experiencing anxiety for quite a few years, but just recently you moved out of home for the first time and that was what led you to go to the GP. So how did that change things? How were things after you moved out?""",116.6,144.45
002_008,002,8,4,"I mean, I'm a photographer, so it's been stopping me a bit, my anxiety, from being able to get work, because every time there's an opportunity that is kind of involving me having to interact with people, I just tend to just turn it down. So I was kind of making things hard in that respect and just kind of friends-wise and everything, I just feel like I'm just kind of increasingly more alone. So it's kind of stopping me. from making friends and, you know, like relationships and stuff.","Therapist: ""Okay, so how do you feel about being here today? A bit scared, I don't know, hopefully it will help. Okay, so you've been feeling a little bit anxious about today? Yeah. Okay, so I guess just going back to why you went to the GP and how you've ended up coming here today. So it sounds like you've been experiencing anxiety for quite a few years, but just recently you moved out of home for the first time and that was what led you to go to the GP. So how did that change things? How were things after you moved out?""
Patient: ""I thought that they'd be better but because I thought I'd have to kind of be independent and space actually a lot worse I'm I'm just kind of staying in the house a lot I don't really have any friends or anything I mean my family come and visit a bit but it's not I don't know it's kind of scary because I've just been kind of literally just in the flat by myself which I always thought I'd like but I don't actually like it""
Therapist: ""Okay, so what are the kind of difficulties that you have been experiencing?""",149.15,185.63
002_010,002,10,2,Yeah. yeah um it was kind of easier when i was at home because i was obviously i mean my parents said that's fine but you know they would i'd go to places with them or i'd kind of have people there but more and more i'm just finding myself just staying in a lot i mean I went like two weeks ago for coffee with my friends and the whole time I was just kind of wanting to go home again. So I just don't want that to happen. I don't want to lose everyone. So you're kind of worried about where this is going to lead to?,"Therapist: ""Okay, so what are the kind of difficulties that you have been experiencing?""
Patient: ""I mean, I'm a photographer, so it's been stopping me a bit, my anxiety, from being able to get work, because every time there's an opportunity that is kind of involving me having to interact with people, I just tend to just turn it down. So I was kind of making things hard in that respect and just kind of friends-wise and everything, I just feel like I'm just kind of increasingly more alone. So it's kind of stopping me. from making friends and, you know, like relationships and stuff.""
Therapist: ""Okay, so you said that your difficulties are getting in the way of you doing certain things so they're stopping you from taking up kind of certain types of work and as a freelance photographer I guess that can be kind of a problem and they're also stopping you or you feel like it's stunting you socially, you're not kind of able to make new friends and get to meet new people.""",205.65,238.63
002_012,002,12,4,"Yeah. And what was happening around that time? I guess I'd finished school about a year before that. And I mean, I've always been a bit shy at school, but it was never, ever like it didn't really affect things as much as not at all as much as it has been doing the last few years, I guess. It just started when my friends went to university and I don't know, I felt like I was expected to kind of move out or just do something and then it just kind of escalated from there. I'd just stop going to parties or I'd just say no to invitations or I don't know, I thought my job would help because I mean I love it, I really like doing photography but I'm just kind of getting less and less work as it goes on. Which is my fault, I keep saying no. What kind of work is the most difficult for you in your job? I guess when I have to be working with other people. I don't like that. It's like when I'm trying to... kind of would do an event or something where there's a lot of people there not just photographers but actual you know if I'm like taking photos of people that I don't know I just kind of find myself saying no I mean I want to do them but just it's scary so I just don't do it","Therapist: ""Okay, so you said that your difficulties are getting in the way of you doing certain things so they're stopping you from taking up kind of certain types of work and as a freelance photographer I guess that can be kind of a problem and they're also stopping you or you feel like it's stunting you socially, you're not kind of able to make new friends and get to meet new people.""
Patient: ""Yeah. yeah um it was kind of easier when i was at home because i was obviously i mean my parents said that's fine but you know they would i'd go to places with them or i'd kind of have people there but more and more i'm just finding myself just staying in a lot i mean I went like two weeks ago for coffee with my friends and the whole time I was just kind of wanting to go home again. So I just don't want that to happen. I don't want to lose everyone. So you're kind of worried about where this is going to lead to?""
Therapist: ""Yeah. So you said that you first noticed the anxiety kicking in about five or six years ago. So you would have been about 19?""",249.17,328.88
002_014,002,14,4,"Just, I mean, I get really hot and sweaty and I don't, I feel like everyone's kind of looking at me and thinking that I'm just like really stupid and I feel like they're all going to be staring and thinking I just can't do my job and I'm just an idiot and I mean, they'll think that I just look like a weirdo and I just try and, I mean, I just kind of just try and get out of the situation or just focus on something else, so... That's why I like doing shots where it's just me and the camera because then I can just put all my attention on that instead of having to, you know, be with other people.","Therapist: ""Yeah. So you said that you first noticed the anxiety kicking in about five or six years ago. So you would have been about 19?""
Patient: ""Yeah. And what was happening around that time? I guess I'd finished school about a year before that. And I mean, I've always been a bit shy at school, but it was never, ever like it didn't really affect things as much as not at all as much as it has been doing the last few years, I guess. It just started when my friends went to university and I don't know, I felt like I was expected to kind of move out or just do something and then it just kind of escalated from there. I'd just stop going to parties or I'd just say no to invitations or I don't know, I thought my job would help because I mean I love it, I really like doing photography but I'm just kind of getting less and less work as it goes on. Which is my fault, I keep saying no. What kind of work is the most difficult for you in your job? I guess when I have to be working with other people. I don't like that. It's like when I'm trying to... kind of would do an event or something where there's a lot of people there not just photographers but actual you know if I'm like taking photos of people that I don't know I just kind of find myself saying no I mean I want to do them but just it's scary so I just don't do it""
Therapist: ""So tell me a bit more about what happens then. So let's focus on maybe an invitation to do a job with, you know, it's going to involve photography with a group of people and you're going to have to have social interaction. What kind of thoughts go through your head?""",344.34,384.15
002_016,002,16,4,It just makes me feel like an idiot. It makes me feel like I just shouldn't even bother trying to do it anymore. I should just go home. I think I just don't want to be in that situation. I just feel like everyone else is fine and they're normal and I'm just the freak who can't do normal things.,"Therapist: ""So tell me a bit more about what happens then. So let's focus on maybe an invitation to do a job with, you know, it's going to involve photography with a group of people and you're going to have to have social interaction. What kind of thoughts go through your head?""
Patient: ""Just, I mean, I get really hot and sweaty and I don't, I feel like everyone's kind of looking at me and thinking that I'm just like really stupid and I feel like they're all going to be staring and thinking I just can't do my job and I'm just an idiot and I mean, they'll think that I just look like a weirdo and I just try and, I mean, I just kind of just try and get out of the situation or just focus on something else, so... That's why I like doing shots where it's just me and the camera because then I can just put all my attention on that instead of having to, you know, be with other people.""
Therapist: ""Okay, so it sounds like you have quite a lot of thoughts rushing through your head then at the point where you get that invitation and you think, people will look, people will stare, people will think I'm a weirdo. So there's quite a lot about what you think other people will think. Yeah. And how does that make you feel?""",401.05,421.03
002_018,002,18,2,"Yeah, I was doing a job where it was kind of like a nature shoot and I was having to work with a lot of different people and when they told me about the job I thought it would be fine, I thought it was just going to be a few other photographers but there were actually people in, you know, I was taking photos of people kind of in the trees and stuff like that and I get they asked me to um that sounds quite interesting was that a fashion shoot or something yeah yeah it was a fashion thing I think it was for some kind of I'm not sure if it was a campaign or something but it was yeah it was really cool but I find it found it really hard to try and focus on that because I was kind of feeling really anxious. So it wasn't what you expected?","Therapist: ""Okay, so it sounds like you have quite a lot of thoughts rushing through your head then at the point where you get that invitation and you think, people will look, people will stare, people will think I'm a weirdo. So there's quite a lot about what you think other people will think. Yeah. And how does that make you feel?""
Patient: ""It just makes me feel like an idiot. It makes me feel like I just shouldn't even bother trying to do it anymore. I should just go home. I think I just don't want to be in that situation. I just feel like everyone else is fine and they're normal and I'm just the freak who can't do normal things.""
Therapist: ""Okay. Can you give me an example of a recent situation? Maybe we can focus on that. like a work situation or just... Yeah, a time when you were maybe doing a job with some people and you felt the social anxiety, you know, that you're describing, you felt that kick in.""",435.3,478.14
002_020,002,20,4,"Just really kind of hot. I couldn't really breathe and just felt like I wanted to just get out. And I was kind of trying really, really hard to just focus and just, you know, like kind of hold the camera and just not think about anything. But I just felt like everyone was looking at me and like when they'd say action and they try and get me to start. And I was just felt like everyone was just thinking I was really stupid and I shouldn't have been there.","Therapist: ""Okay. Can you give me an example of a recent situation? Maybe we can focus on that. like a work situation or just... Yeah, a time when you were maybe doing a job with some people and you felt the social anxiety, you know, that you're describing, you felt that kick in.""
Patient: ""Yeah, I was doing a job where it was kind of like a nature shoot and I was having to work with a lot of different people and when they told me about the job I thought it would be fine, I thought it was just going to be a few other photographers but there were actually people in, you know, I was taking photos of people kind of in the trees and stuff like that and I get they asked me to um that sounds quite interesting was that a fashion shoot or something yeah yeah it was a fashion thing I think it was for some kind of I'm not sure if it was a campaign or something but it was yeah it was really cool but I find it found it really hard to try and focus on that because I was kind of feeling really anxious. So it wasn't what you expected?""
Therapist: ""No. So how long ago was that? That was two weeks ago. Okay, so it was quite recent. So on that particular day what were the thoughts that you had in your head when you were in that situation? I just felt really""",490.42,516.49
002_022,002,22,4,because i felt like i was getting really like hot and flushed and i just thought at least if i can just i don't know it sounds weird but i was just trying to keep my hands still on it because my hands were kind of sweaty and like shaking like loads like and i could just tell everyone was looking and they could see and i just thought if i just managed to hold on to it it wouldn't be as noticeable but,"Therapist: ""No. So how long ago was that? That was two weeks ago. Okay, so it was quite recent. So on that particular day what were the thoughts that you had in your head when you were in that situation? I just felt really""
Patient: ""Just really kind of hot. I couldn't really breathe and just felt like I wanted to just get out. And I was kind of trying really, really hard to just focus and just, you know, like kind of hold the camera and just not think about anything. But I just felt like everyone was looking at me and like when they'd say action and they try and get me to start. And I was just felt like everyone was just thinking I was really stupid and I shouldn't have been there.""
Therapist: ""And I can tell you're getting kind of anxious even just thinking about that day. Yeah. okay so you're describing quite a lot there to me so you're saying that you you kind of got hot and sweaty you said that you held the camera yeah what was do you mean you're kind of trying to hide behind it or i was just trying to focus on it i was just thinking if i could just hold it really tightly it would just i don't know i'd kind of just be able to just get through it and just so you're holding the camera very tightly yeah and why was that why was that helpful""",545.78,566.27
002_024,002,24,4,"just stupid and it was just really, just felt really like, kind of, like everyone was just gonna be staring and just thinking that, I just felt like everyone was looking at me and just, they could tell and just thinking, what's she doing? They could tell what I was just really like sweaty and just so that they could see that. Yeah. OK. Yeah. So I was trying to wear black. So this kind of tries to cover it up and just like a lot of layers. So they can't tell. But I mean, my hands like they were so shaken. I was really red and just was just wishing that I just wasn't there.","Therapist: ""And I can tell you're getting kind of anxious even just thinking about that day. Yeah. okay so you're describing quite a lot there to me so you're saying that you you kind of got hot and sweaty you said that you held the camera yeah what was do you mean you're kind of trying to hide behind it or i was just trying to focus on it i was just thinking if i could just hold it really tightly it would just i don't know i'd kind of just be able to just get through it and just so you're holding the camera very tightly yeah and why was that why was that helpful""
Patient: ""because i felt like i was getting really like hot and flushed and i just thought at least if i can just i don't know it sounds weird but i was just trying to keep my hands still on it because my hands were kind of sweaty and like shaking like loads like and i could just tell everyone was looking and they could see and i just thought if i just managed to hold on to it it wouldn't be as noticeable but""
Therapist: ""Okay, so it sounds like you had a lot of thoughts going through your head. You said that you're worried that everyone's looking at you. What other thoughts were there that were in your mind?""",580.04,618.6
002_026,002,26,4,"I think just really stupid and I think my face was really red. I could feel it flushing and I knew that I was probably sweating and shaking. My hands were definitely really, really shaking. And it was definitely really noticeable. Everyone could definitely see. Okay, and what did you do about, how did you try and conceal that or hide that? Well, again, I was trying to grip the camera, just look down, just trying not to do anything weird. Because, I mean, they could probably tell I was being weird anyway, but hopefully, I just tried really hard to just focus and look down, not look at anyone else and just, yeah, just kind of try and get on with it as best as I could.","Therapist: ""Okay, so it sounds like you had a lot of thoughts going through your head. You said that you're worried that everyone's looking at you. What other thoughts were there that were in your mind?""
Patient: ""just stupid and it was just really, just felt really like, kind of, like everyone was just gonna be staring and just thinking that, I just felt like everyone was looking at me and just, they could tell and just thinking, what's she doing? They could tell what I was just really like sweaty and just so that they could see that. Yeah. OK. Yeah. So I was trying to wear black. So this kind of tries to cover it up and just like a lot of layers. So they can't tell. But I mean, my hands like they were so shaken. I was really red and just was just wishing that I just wasn't there.""
Therapist: ""So, I mean, you've already described it to me a little bit, but if you think about how you looked that day, how do you think you looked?""",626.49,670.94
002_028,002,28,2,"Yeah. No, I always do that, even if it's really hot or I wear just loads of layers and just because otherwise I'll just be really sweaty and like people would definitely be able to see. And how did it end? Well, it kind of went on for like an hour or so and then people were going um just after every shoot people go out for drinks after just to kind of celebrate like that we've done it but i just i went home straight away just got in my car and went home i just didn't want to be around them especially after they would have seen me being weird and i just wanted to get get home straight away okay","Therapist: ""So, I mean, you've already described it to me a little bit, but if you think about how you looked that day, how do you think you looked?""
Patient: ""I think just really stupid and I think my face was really red. I could feel it flushing and I knew that I was probably sweating and shaking. My hands were definitely really, really shaking. And it was definitely really noticeable. Everyone could definitely see. Okay, and what did you do about, how did you try and conceal that or hide that? Well, again, I was trying to grip the camera, just look down, just trying not to do anything weird. Because, I mean, they could probably tell I was being weird anyway, but hopefully, I just tried really hard to just focus and look down, not look at anyone else and just, yeah, just kind of try and get on with it as best as I could.""
Therapist: ""So you avoided looking at people. It sounds like you wore black as well in kind of preparation anyway. Yeah.""",677.45,719.33
003_003,003,3,2,"Well, it was a few months ago now. Yeah, I'd done quite well for a number of years, sort of kept it under control really.","Therapist: ""Nice to see you again, Tom. How are you today?""
Patient: ""I'm okay.""
Therapist: ""So I understand that since I was seeing you that while ago, that you were in hospital again. Yeah. So can you tell me a bit more about what happened before that?""",48.46,58.95
003_005,003,5,4,"Yeah, so that was four years ago. So, yeah, it was quite disappointing to go through it all again. But it sort of started towards the end of university. So I was doing law and... Well, I was on course for a first and I was just coming up to my final exams and I had a few essays and a few exams. So I just started working really hard. I felt like now was the real time to put the effort in and to put the work in. So I started to step a bit later, take on a bit more work. So my stress levels sort of start to increase over a while. I was drinking a lot more coffee, took a few caffeine tablets and energy drinks. Because the environment at the time was a lot of people were pushing themselves that they wouldn't normally do and some people were taking Ritalin. Did you take any Ritalin? Yeah, because that was necessary at the time.","Therapist: ""So I understand that since I was seeing you that while ago, that you were in hospital again. Yeah. So can you tell me a bit more about what happened before that?""
Patient: ""Well, it was a few months ago now. Yeah, I'd done quite well for a number of years, sort of kept it under control really.""
Therapist: ""Yeah, I mean, I've not seen you since your gap year, wasn't it?""",63.66,148.28
003_007,003,7,1,"Well, it sort of increased my confidence at the time. Everything that was going on, I was becoming a lot more productive, a lot more confident, I was working harder, my brain was working faster. And so I... Yeah, my momentum was building up and up throughout the period. Yeah, and so I was relishing it and I was doing a lot of work.","Therapist: ""Yeah, I mean, I've not seen you since your gap year, wasn't it?""
Patient: ""Yeah, so that was four years ago. So, yeah, it was quite disappointing to go through it all again. But it sort of started towards the end of university. So I was doing law and... Well, I was on course for a first and I was just coming up to my final exams and I had a few essays and a few exams. So I just started working really hard. I felt like now was the real time to put the effort in and to put the work in. So I started to step a bit later, take on a bit more work. So my stress levels sort of start to increase over a while. I was drinking a lot more coffee, took a few caffeine tablets and energy drinks. Because the environment at the time was a lot of people were pushing themselves that they wouldn't normally do and some people were taking Ritalin. Did you take any Ritalin? Yeah, because that was necessary at the time.""
Therapist: ""How did that affect you?""",152.06,187.96
003_009,003,9,2,"Yeah, well, for me, it was my sort of time. So I'd spent three years, I'd I was in control. I was doing well. It wasn't really part of my life at the time. I didn't really talk to any of my friends about it. But then I started to just sort of grow into it. And I took the opportunity to enjoy this time. And it didn't really reach its peak until after my exams. I was still functioning throughout my exams. I have since found out that I didn't get the results that I wanted to.","Therapist: ""How did that affect you?""
Patient: ""Well, it sort of increased my confidence at the time. Everything that was going on, I was becoming a lot more productive, a lot more confident, I was working harder, my brain was working faster. And so I... Yeah, my momentum was building up and up throughout the period. Yeah, and so I was relishing it and I was doing a lot of work.""
Therapist: ""So what did that mean to you then to be at that time, because it sounds like you put quite a lot of pressure on yourself. You've been doing really well at uni and, you know, this was it, this was the time. What did it mean to you to be feeling like that kind of more awake and more energised maybe?""",203.66,258.82
003_011,003,11,4,"I thought that I was working harder than ever, but... It was misjudged I think and so I didn't perform to the best of my ability when it came to the exams and so I didn't achieve a first high and only got two on.","Therapist: ""So what did that mean to you then to be at that time, because it sounds like you put quite a lot of pressure on yourself. You've been doing really well at uni and, you know, this was it, this was the time. What did it mean to you to be feeling like that kind of more awake and more energised maybe?""
Patient: ""Yeah, well, for me, it was my sort of time. So I'd spent three years, I'd I was in control. I was doing well. It wasn't really part of my life at the time. I didn't really talk to any of my friends about it. But then I started to just sort of grow into it. And I took the opportunity to enjoy this time. And it didn't really reach its peak until after my exams. I was still functioning throughout my exams. I have since found out that I didn't get the results that I wanted to.""
Therapist: ""Why do you think that was?""",261.7,289.7
003_013,003,13,2,"Well, so it was the end of university and that was the time where Well, as soon as that period stopped of work, then I was sort of left the leash a bit. And yeah, I just thought to grow even further. So I mentioned those. I was taking Ritalin, drinking a lot of coffee, and as soon as my exams had stopped, I just, substance abuse sort of took a bit more of a hold. And yeah, I just sort of grew into this person who I thought was him, was... the guy that everyone wanted to be around and to see. And so I made sure that I was just everywhere to be seen.","Therapist: ""Why do you think that was?""
Patient: ""I thought that I was working harder than ever, but... It was misjudged I think and so I didn't perform to the best of my ability when it came to the exams and so I didn't achieve a first high and only got two on.""
Therapist: ""What else was happening for you around that time? I mean, you talked about the pressure of your exams and staying up for them. Was anything else going on for you around the same time?""",302.47,368.83
003_015,003,15,2,"Yeah. So we were just going out a lot, if not every night.","Therapist: ""What else was happening for you around that time? I mean, you talked about the pressure of your exams and staying up for them. Was anything else going on for you around the same time?""
Patient: ""Well, so it was the end of university and that was the time where Well, as soon as that period stopped of work, then I was sort of left the leash a bit. And yeah, I just thought to grow even further. So I mentioned those. I was taking Ritalin, drinking a lot of coffee, and as soon as my exams had stopped, I just, substance abuse sort of took a bit more of a hold. And yeah, I just sort of grew into this person who I thought was him, was... the guy that everyone wanted to be around and to see. And so I made sure that I was just everywhere to be seen.""
Therapist: ""So this is like the gap after you finish the exams, but before the results are out.""",373.2,382.78
003_019,003,19,3,"Yeah, it sort of developed into cocaine, a lot of cocaine, MDMA, MCAT. And how did they affect you? I honestly was on cloud nine at the time. Yeah, I I was the person everyone wanted to know in my head. I put myself at the centre of the universe. I even, I convinced a friend of mine who develops apps that we should, I had an idea to develop an app about when you go into a alcohol shop that it all weigh up, like what's the most cost effective way to get wasted. Right. Yeah, I mean, at the time I was spending a lot of money, a lot of my parents' savings. I'd got a credit card, which I didn't tell them about. And so in this sort of role as the man, as the man about town, I was spent a lot on alcohol, drugs, clothes, invested in this technology. And yeah, I was","Therapist: ""You said that you were taking Ritalin and drinking a lot of coffee.""
Patient: ""Yeah.""
Therapist: ""And using other drugs as well.""",388.78,485.83
003_021,003,21,3,"Well, Having not had to deal with my illness throughout university and for it not being a part of that world, I didn't confront those symptoms in a way that's going to have long-term stability. Well, it began with doing the work that I needed to do. That's just what I needed to do in order to achieve my goals and to achieve what I want to. And then it just... I just let it take hold and I... It was all part of me. It wasn't the illness, it was me. It was just... I was... I was the master of this whole situation and I was, everything that was happening was down to my own doing.","Therapist: ""And using other drugs as well.""
Patient: ""Yeah, it sort of developed into cocaine, a lot of cocaine, MDMA, MCAT. And how did they affect you? I honestly was on cloud nine at the time. Yeah, I I was the person everyone wanted to know in my head. I put myself at the centre of the universe. I even, I convinced a friend of mine who develops apps that we should, I had an idea to develop an app about when you go into a alcohol shop that it all weigh up, like what's the most cost effective way to get wasted. Right. Yeah, I mean, at the time I was spending a lot of money, a lot of my parents' savings. I'd got a credit card, which I didn't tell them about. And so in this sort of role as the man, as the man about town, I was spent a lot on alcohol, drugs, clothes, invested in this technology. And yeah, I was""
Therapist: ""So it sounds like it began with kind of the exam pressure and putting more pressure on yourself to stay up using kind of stimulants to keep yourself awake. And then you started to feel like you were more and more the man you were, you were kind of popular. You were successful. How did you respond and cope with those symptoms? What did you do once those are kind of begun?""",511.43,582.16
003_023,003,23,3,"It was my time. It had all been leading to like this was the moment where I would sort of like become the person that I wanted to be. All the hard work, everything, like all the work that my parents had done for me all the work that I'd been doing, it was now crystallizing.","Therapist: ""So it sounds like it began with kind of the exam pressure and putting more pressure on yourself to stay up using kind of stimulants to keep yourself awake. And then you started to feel like you were more and more the man you were, you were kind of popular. You were successful. How did you respond and cope with those symptoms? What did you do once those are kind of begun?""
Patient: ""Well, Having not had to deal with my illness throughout university and for it not being a part of that world, I didn't confront those symptoms in a way that's going to have long-term stability. Well, it began with doing the work that I needed to do. That's just what I needed to do in order to achieve my goals and to achieve what I want to. And then it just... I just let it take hold and I... It was all part of me. It wasn't the illness, it was me. It was just... I was... I was the master of this whole situation and I was, everything that was happening was down to my own doing.""
Therapist: ""So it sounds you say on the one hand, you didn't confront it, you kind of just let it roll. And on the other hand, you said that you kind of took it as evidence that you were very energetic, you were powerful. This was all kind of explained about who you were in it. I guess, how did that affect you looking at things in that way?""",621.32,649.23
003_025,003,25,2,"It gradually diminished, I think. It began at six, five, and then ended up about three and two hours.","Therapist: ""So it sounds you say on the one hand, you didn't confront it, you kind of just let it roll. And on the other hand, you said that you kind of took it as evidence that you were very energetic, you were powerful. This was all kind of explained about who you were in it. I guess, how did that affect you looking at things in that way?""
Patient: ""It was my time. It had all been leading to like this was the moment where I would sort of like become the person that I wanted to be. All the hard work, everything, like all the work that my parents had done for me all the work that I'd been doing, it was now crystallizing.""
Therapist: ""It felt like you were on the brink of something enormous from the sounds of it. Again, going back to that kind of beginning stage where you started to stay up late and use stimulants. I mean, how much sleep were you getting at the beginning?""",668.64,683.44
003_027,003,27,3,think the harder i was working the faster my brain then would work and how much yeah the harder i worked the more i would do so it was it wasn't it was just a yeah the momentum was building more than anything and my thoughts were firing and my goals were stronger and my um yeah my determination was,"Therapist: ""It felt like you were on the brink of something enormous from the sounds of it. Again, going back to that kind of beginning stage where you started to stay up late and use stimulants. I mean, how much sleep were you getting at the beginning?""
Patient: ""It gradually diminished, I think. It began at six, five, and then ended up about three and two hours.""
Therapist: ""What kind of things did you notice? Did you notice any changes from having less and less sleep in your body, maybe, or the way you were thinking?""",694.6,722.38
003_029,003,29,2,"Not that I can recall at the time. Maybe I was avoiding confronting any negative effects, but nothing powerful comes to mind.","Therapist: ""What kind of things did you notice? Did you notice any changes from having less and less sleep in your body, maybe, or the way you were thinking?""
Patient: ""think the harder i was working the faster my brain then would work and how much yeah the harder i worked the more i would do so it was it wasn't it was just a yeah the momentum was building more than anything and my thoughts were firing and my goals were stronger and my um yeah my determination was""
Therapist: ""And how did you feel in your body? Did you notice any changes physically?""",735.05,751.79
003_031,003,31,4,"I hired a lot of savings that my... that my parents had built up for me, which don't really exist anymore, either through the money I invested and through drugs, clothes. I had a girlfriend at the time, but because it was because I was the main character. In a sense, I was only the person that mattered. And so sort of those around me especially didn't really have as much importance. So on nights out I wouldn't she just wouldn't be in my mind and so there would be other women okay so and how do you feel about that now looking back on it I think It's those moments where it's not just me, it's those closest to you and those around you that have to suffer more than anyone else. That brings a lot of the shame.","Therapist: ""And how did you feel in your body? Did you notice any changes physically?""
Patient: ""Not that I can recall at the time. Maybe I was avoiding confronting any negative effects, but nothing powerful comes to mind.""
Therapist: ""And once things were a bit further along after your exams, you said you were going out a lot, you convinced your friend to do this app. Was there anything else that you did that maybe you wouldn't normally do that you think might have been a sign to you that your mood was much higher than you'd like it to be?""",771.7,883.77
004_001,004,1,2,"Yeah, that's something that's always on my mind.","Therapist: ""Okay, so you said that when you're at work, you really worry that you're going to say something stupid.""",38.17,40.8
004_003,004,3,2,Because people would think I was weird.,"Therapist: ""Okay, so you said that when you're at work, you really worry that you're going to say something stupid.""
Patient: ""Yeah, that's something that's always on my mind.""
Therapist: ""What would be so bad about that if you did say something stupid at work?""",46.58,48.63
004_007,004,7,2,"Well, I just have no one to talk to at work.","Therapist: ""Then what would be so bad if people at work thought you were weird?""
Patient: ""They wouldn't want to be friends with me.""
Therapist: ""And what would be so bad about that if people at work didn't want to be friends with you?""",61.25,64.8
004_009,004,9,4,"I mean, the shoots can go on the whole day, so I'd just be by myself the whole time.","Therapist: ""And what would be so bad about that if people at work didn't want to be friends with you?""
Patient: ""Well, I just have no one to talk to at work.""
Therapist: ""Then what would be so bad about having no one to talk to at work?""",70.54,76.71
004_011,004,11,4,"I don't know. I guess I should be used to it now. I spend a lot of my time by myself. Oh, that must be tough.","Therapist: ""Then what would be so bad about having no one to talk to at work?""
Patient: ""I mean, the shoots can go on the whole day, so I'd just be by myself the whole time.""
Therapist: ""And what would be so bad about being by yourself for a whole day?""",83.67,90.9
004_013,004,13,2,"Do you know, I guess it's just like I spend so much time by myself that it's kind of like I'm not even worth being friends with.","Therapist: ""And what would be so bad about being by yourself for a whole day?""
Patient: ""I don't know. I guess I should be used to it now. I spend a lot of my time by myself. Oh, that must be tough.""
Therapist: ""What does that mean to you that you spend a lot of time on your own?""",97.51,104.62
004_015,004,15,4,"I guess like 90 out of 100. When did you start believing that? I think it was probably at school. Yeah, I think at school.","Therapist: ""What does that mean to you that you spend a lot of time on your own?""
Patient: ""Do you know, I guess it's just like I spend so much time by myself that it's kind of like I'm not even worth being friends with.""
Therapist: ""So it sounds like deep down that you think that you're not worth being friends with. And that's quite a negative belief. I mean, how much would you say that you believe that out of a hundred? If a hundred is where you believe it totally and zero is where you don't believe it at all.""",121.37,134.7
004_017,004,17,2,just like quite a lot of things like I wouldn't have anyone sit with at lunch or people's birthdays and stuff I wasn't invited and you know like I was the last one picked for teams and stuff like that.,"Therapist: ""So it sounds like deep down that you think that you're not worth being friends with. And that's quite a negative belief. I mean, how much would you say that you believe that out of a hundred? If a hundred is where you believe it totally and zero is where you don't believe it at all.""
Patient: ""I guess like 90 out of 100. When did you start believing that? I think it was probably at school. Yeah, I think at school.""
Therapist: ""And what was it about school that made you start to believe that you weren't worth being friends with?""",140.84,154.49
004_019,004,19,4,"I mean, it's kind of similar at work. Obviously, the difference is that it's work, not school. But people go for drinks and stuff after work or after a shoot, and I'm just kind of excluded a lot of the time.","Therapist: ""And what was it about school that made you start to believe that you weren't worth being friends with?""
Patient: ""just like quite a lot of things like I wouldn't have anyone sit with at lunch or people's birthdays and stuff I wasn't invited and you know like I was the last one picked for teams and stuff like that.""
Therapist: ""And what is it now that makes you think that that's still true?""",160.62,176.73
004_021,004,21,2,I guess my friends and family would say that I am. Like I try to make a lot of time for my friends and stuff.,"Therapist: ""And what is it now that makes you think that that's still true?""
Patient: ""I mean, it's kind of similar at work. Obviously, the difference is that it's work, not school. But people go for drinks and stuff after work or after a shoot, and I'm just kind of excluded a lot of the time.""
Therapist: ""That sounds tough. Is there anything that makes you think that it's not true, that you are worth being friends with?""",186.05,195.46
004_024,004,24,2,Just like I kind of don't go to a lot of stuff. People have like gatherings and things and a lot of the time I just I don't go and rather just stay at home.,"Patient: ""I guess my friends and family would say that I am. Like I try to make a lot of time for my friends and stuff.""
Therapist: ""Okay, so it sounds like deep down you have this thought that you're not worth being friends with and that started at school when you had trouble making friends at school and that you won't always pick for teams and that now at work it feels like the same thing is happening and that you're not always invited out for drinks with people after work and that sometimes you feel that you're excluded from their social groups but then that's not the whole story that on the other hand you are close to family and you do have friends who would say that it's not true that you are with being friends with and in CBT we do a thing called thought challenging where when we have these negative thoughts sometimes we We actually put them up to scrutiny. We weigh up the evidence for and against them. I like to think of it as putting the thought on trial. Could we do that now where we just actually try and weigh up the evidence for and against that thought a bit more? Okay. Okay. So if I just put two columns here, so for and against, and it sounds like the evidence for this thought that makes you think that it is true is difficulty at school, making friends, being picked for teams, and difficulty at work, feeling excluded sometimes from groups.""
Therapist: ""But actually in this other column, we have that you are close with your family and that you have some close friends. Okay, now moving back to this first column, is there anything else that makes you think it's true that you're not worth being friends with?""",290.54,302.92
004_026,004,26,2,"Mainly big ones. If there's a lot of people there, I just find it really, it kind of makes me really anxious, so a lot of the time I just prefer not even to be in that situation in the first place.","Therapist: ""But actually in this other column, we have that you are close with your family and that you have some close friends. Okay, now moving back to this first column, is there anything else that makes you think it's true that you're not worth being friends with?""
Patient: ""Just like I kind of don't go to a lot of stuff. People have like gatherings and things and a lot of the time I just I don't go and rather just stay at home.""
Therapist: ""Don't go to parties. What kind of parties are we talking like big parties, small parties?""",309.91,321.3
004_028,004,28,2,"I mean, I guess my friends would say that I was. I do have close friends and you know when it's like their stuff that's important to them I always make sure that I think about that and even if I find it stressful I'll always make sure that I can kind of put them first.","Therapist: ""Don't go to parties. What kind of parties are we talking like big parties, small parties?""
Patient: ""Mainly big ones. If there's a lot of people there, I just find it really, it kind of makes me really anxious, so a lot of the time I just prefer not even to be in that situation in the first place.""
Therapist: ""Okay. So you don't go to larger parties and events. Okay. Is there anything else that maybe makes you think that it's not true, that actually you are worth being friends with?""",332.57,353.59
004_030,004,30,2,"Yeah, I do make sure I try and do that. In what kind of ways do you put your friends first? I guess when it's birthdays or something important to them, I'll always make sure that I'm there and that I put a lot of thought into presents and stuff like that.","Therapist: ""Okay. So you don't go to larger parties and events. Okay. Is there anything else that maybe makes you think that it's not true, that actually you are worth being friends with?""
Patient: ""I mean, I guess my friends would say that I was. I do have close friends and you know when it's like their stuff that's important to them I always make sure that I think about that and even if I find it stressful I'll always make sure that I can kind of put them first.""
Therapist: ""Okay so your friends would say that you are worth being friends with and it sounds like you put your friends first.""",362.23,382.21
004_032,004,32,1,It was my friend's birthday a few weeks ago and we did a big surprise at hers and I made a cake and stuff like that.,"Therapist: ""Okay so your friends would say that you are worth being friends with and it sounds like you put your friends first.""
Patient: ""Yeah, I do make sure I try and do that. In what kind of ways do you put your friends first? I guess when it's birthdays or something important to them, I'll always make sure that I'm there and that I put a lot of thought into presents and stuff like that.""
Therapist: ""Can you give me an example of a time that you've done that?""",385.87,393.12
004_035,004,35,2,I guess that I kind of always put myself in a situation even if I find it kind of it makes me anxious if it's for my close friends and I know that it's something that's important to them then I'll always put them first and make sure I'm there.,"Patient: ""It was my friend's birthday a few weeks ago and we did a big surprise at hers and I made a cake and stuff like that.""
Therapist: ""So you actually helped to organise events for your friends?""
Therapist: ""Is there anything that you do that you wouldn't do if you weren't a good friend?""",404.11,420.83
004_038,004,38,2,"I mean, I still have my friends, so I guess if I wasn't worth being friends with, I wouldn't have these friends that I've had for quite a long time.","Patient: ""I guess that I kind of always put myself in a situation even if I find it kind of it makes me anxious if it's for my close friends and I know that it's something that's important to them then I'll always put them first and make sure I'm there.""
Therapist: ""So you'll tolerate your anxiety if it means something to a friend of yours?""
Therapist: ""Okay, so at the moment in the four category, we've got that you had difficulty making friends at school, that you're having difficulty now at work making friends, and that you don't go to larger parties or events. But actually, there's a lot of evidence in the against column, evidence that would suggest that actually you are worth being friends with and you're a good friend. that you're close with your family, you're close with your friends. Your friends would say that you're a good friend. You put your friends first. Even when you're anxious, you tolerate that anxiety if you know it will mean something to them. But when things are important to your friends, like birthdays, you'll make a real effort. You'll even actually go to the effort of organising events and baking cakes and doing things like that for other people. Is there anything else that you do that makes you think that maybe you are a good friend, you are worth being friends with?""",475.98,484.66
004_042,004,42,2,"It's weird. There's actually kind of more stuff in the against than there is in the for. I guess also a lot of the stuff that is in the four columns, kind of things that I make happen, like I don't go to things. Yeah, it seems like some of it's kind of in my hands.","Therapist: ""Okay, so it sounds like you've got long-term friendships as well, so you might have trouble making friends, but when you make them, you stick with them.""
Therapist: ""Okay, I'm just going to give you this list now to have a look at. Okay.""
Therapist: ""How do you feel now that you're looking at that list?""",508.28,527.3
004_044,004,44,2,"Yeah, yeah, I think so, yeah.","Therapist: ""How do you feel now that you're looking at that list?""
Patient: ""It's weird. There's actually kind of more stuff in the against than there is in the for. I guess also a lot of the stuff that is in the four columns, kind of things that I make happen, like I don't go to things. Yeah, it seems like some of it's kind of in my hands.""
Therapist: ""So it's not that you're not worth being friends with, but actually that you're choosing not to engage with people always.""",533.25,535.68
004_046,004,46,2,"I guess I'd say maybe 40. I think, I do still think that it might be true, but I think I believe it less than I did before.","Therapist: ""So it's not that you're not worth being friends with, but actually that you're choosing not to engage with people always.""
Patient: ""Yeah, yeah, I think so, yeah.""
Therapist: ""Okay. And if I was to ask you now, you know, this idea that you're not worth being friends with, how much do you believe that now that we've done this exercise where 100 is where you really believe that you're not worth being friends with and zero is that you don't believe it?""",549.52,561.36
005_001,005,1,2,"Yeah, it really makes me feel really anxious, like what I look like and what people are thinking.","Therapist: ""You said that when you're in work you worry a lot about how you come across in social situations.""",34.8,40.81
005_004,005,4,2,"I think, obviously, the shaking. I think my hands and legs shaking and kind of going really red and sweating and just looking really weird.","Patient: ""Yeah, it really makes me feel really anxious, like what I look like and what people are thinking.""
Therapist: ""Yeah, you said that you worry that you visibly shake.""
Therapist: ""Are there any other things that you worry that people will notice?""",50.31,60.81
005_006,005,6,2,I think I just look really obviously weird and out of place and really red and just visibly shaking and sweating and kind of not being able to communicate properly with people.,"Therapist: ""Are there any other things that you worry that people will notice?""
Patient: ""I think, obviously, the shaking. I think my hands and legs shaking and kind of going really red and sweating and just looking really weird.""
Therapist: ""So it sounds like you have quite a strong mental image of how you see yourself when you're in these social situations. Yeah, definitely. So you go red, you shake. Is there anything else that you think that you do? I mean, describe yourself. How do you think you look when you're in these situations?""",76.63,90.85
005_008,005,8,4,I guess like when I'm holding the camera I just grip onto it really really tight or I kind of clench all my muscles and just find something that I can focus on and to kind of try and make myself shake less and not go as red and stuff.,"Therapist: ""So it sounds like you have quite a strong mental image of how you see yourself when you're in these social situations. Yeah, definitely. So you go red, you shake. Is there anything else that you think that you do? I mean, describe yourself. How do you think you look when you're in these situations?""
Patient: ""I think I just look really obviously weird and out of place and really red and just visibly shaking and sweating and kind of not being able to communicate properly with people.""
Therapist: ""Is there anything that you do to try and defend against these things, to manage these problems?""",98.61,116.09
005_010,005,10,2,"I just, as I, like, kind of looking down and, like, wearing all black so it's less obvious, or kind of wearing, yeah, just more layers and all black so you just can't tell.","Therapist: ""Is there anything that you do to try and defend against these things, to manage these problems?""
Patient: ""I guess like when I'm holding the camera I just grip onto it really really tight or I kind of clench all my muscles and just find something that I can focus on and to kind of try and make myself shake less and not go as red and stuff.""
Therapist: ""So you focus on something, you grip onto the camera, do you make eye contact with people? No, I just tend to just look down. Okay, so you also avoid eye contact. Is there anything else that you do to manage the sweating, for example?""",131.76,143.64
005_012,005,12,4,"I think it would be so much worse. Yeah, I think I just would just shake even more and be more anxious and look more obviously kind of weird and out of place.","Therapist: ""So you focus on something, you grip onto the camera, do you make eye contact with people? No, I just tend to just look down. Okay, so you also avoid eye contact. Is there anything else that you do to manage the sweating, for example?""
Patient: ""I just, as I, like, kind of looking down and, like, wearing all black so it's less obvious, or kind of wearing, yeah, just more layers and all black so you just can't tell.""
Therapist: ""Okay. What do you think would happen if you stopped doing these things? If you stopped gripping onto the camera or, you know, you started making eye contact and not looking down. What do you think would happen?""",156.5,169.09
005_016,005,16,4,"I just kind of just like fumble and like kind of just clench whatever it is I'm holding just really tight and just make sure I don't make any eye contact at all, just kind of get through it.","Therapist: ""What I'm thinking now is how do you feel about if we did an experiment to to test out your thoughts on what would happen if you stopped doing these things. If we did a bit of a role play where we pretended to enact a situation at work.""
Patient: ""Okay.""
Therapist: ""And if we did this maybe twice, and the first time you do all the things that you normally do, you grip onto something, look down. Is there anything else that you do when you're in these situations, these work conversations, to try and cope?""",202.96,218.73
005_018,005,18,2,"Yeah, is my phone okay?","Therapist: ""And if we did this maybe twice, and the first time you do all the things that you normally do, you grip onto something, look down. Is there anything else that you do when you're in these situations, these work conversations, to try and cope?""
Patient: ""I just kind of just like fumble and like kind of just clench whatever it is I'm holding just really tight and just make sure I don't make any eye contact at all, just kind of get through it.""
Therapist: ""Okay, so in the first time, I want you to do those things as much as you normally would. In fact, maybe even slightly more than you normally would. Okay. And then the second time, I want you to drop doing those things altogether. Okay. How does that sound? Okay, I'll try my best. And how would you feel about if we filmed this so you could actually see what you looked like? Okay. Do you have a camera with you that we could video on?""",242.81,245.03
005_021,005,21,1,Maybe like a client at work. I always have to sit down with clients before we do the shoot and kind of get to know a little bit more about what they want.,"Patient: ""Yeah, is my phone okay?""
Therapist: ""Yeah, we'll use that in just a sec.""
Therapist: ""Before we do this then, we're just going to fill out this form, because what we're doing now is an experiment. We call it a behavioural experiment to see what happens when you change the way that you're behaving. Right, okay. Okay, so the first column says I need to fill out an experiment to test this thought that you have. So our experiment is going to be that we do a conversation at work. Who should I play? If you're playing yourself in this role play, who should I be?""",272.02,280.82
005_024,005,24,4,"Shaking, like being really obviously shaking and bright red.","Patient: ""Maybe like a client at work. I always have to sit down with clients before we do the shoot and kind of get to know a little bit more about what they want.""
Therapist: ""Okay, so would it work if I was maybe having a wedding and I was hiring you to be a wedding photographer?""
Therapist: ""What kind of problems do you see coming up in this conversation that we have? Like what will you see yourself doing on camera?""",292.86,298.21
005_028,005,28,3,"Like I go really red. Okay, so you're going to go red.","Therapist: ""Okay, so visibly shaking. So how much will you be shaking? If 100 is like shaking uncontrollably and zero is not shaking at all, how visibly shaking will you be?""
Patient: ""90.""
Therapist: ""Okay. Sorry, what was the other thing that you just said?""",318.81,321.22
005_031,005,31,2,90 out of 100.,"Patient: ""Like I go really red. Okay, so you're going to go red.""
Therapist: ""Yeah. How red will you go? I mean, if we look around this room. Probably like the chairs. Okay, so you're going to be as kind of brightly pink as these chairs are.""
Therapist: ""Okay, so out of 100 then, how pink would you say these chairs are?""",341.8,344.11
005_033,005,33,2,Worried I'll say something stupid and not be able to kind of get what I'm trying to say across properly.,"Therapist: ""Okay, so out of 100 then, how pink would you say these chairs are?""
Patient: ""90 out of 100.""
Therapist: ""Okay. What else are you worried is going to happen when we have these conversations?""",349.99,357.02
005_035,005,35,2,"Probably like similar, 90, I'd say.","Therapist: ""Okay. What else are you worried is going to happen when we have these conversations?""
Patient: ""Worried I'll say something stupid and not be able to kind of get what I'm trying to say across properly.""
Therapist: ""Okay, and how stupid out of 100, if 100 is ridiculously stupid?""",362.6,366.21
005_037,005,37,2,I think you'll probably be able to see that I'm a bit sweating. Okay.,"Therapist: ""Okay, and how stupid out of 100, if 100 is ridiculously stupid?""
Patient: ""Probably like similar, 90, I'd say.""
Therapist: ""What else are you worried will happen when we have this conversation? What else might you see on the camera?""",374.71,378.7
005_039,005,39,2,"Again, 90, I think.","Therapist: ""What else are you worried will happen when we have this conversation? What else might you see on the camera?""
Patient: ""I think you'll probably be able to see that I'm a bit sweating. Okay.""
Therapist: ""And how much will you be sweating?""",383.59,387.2
005_047,005,47,2,Yep. What kind of things do you see? How do you want it to be like?,"Therapist: ""How much worse? Slightly worse? Like twice as bad? Twice as bad. Okay. Yeah. Okay. Right, can you give me your phone and we'll...""
Patient: ""Should I just use this?""
Therapist: ""Yeah, yeah. It's probably best. Okay. Okay. Hi, so I was just wondering if I could talk to you about maybe doing my wedding photography.""",444.28,452.31
005_049,005,49,1,"Yeah. Do you want it, like, do you kind of see it being outside? Is that something that you're interested in, outside shots?","Therapist: ""Yeah, yeah. It's probably best. Okay. Okay. Hi, so I was just wondering if I could talk to you about maybe doing my wedding photography.""
Patient: ""Yep. What kind of things do you see? How do you want it to be like?""
Therapist: ""I suppose I'd like lots of shots of our family and our friends, quite a lot of natural shots, you know, people talking when they're having drinks.""",463.65,470.84
005_051,005,51,1,"Yeah, I've done quite a few things like that before. Have you got anything that you could show me about your past work? Yeah, I recently did some shoots outside, kind of in like a wood environment, so that I could show you that maybe it would kind of help with some ideas. Okay, great.","Therapist: ""I suppose I'd like lots of shots of our family and our friends, quite a lot of natural shots, you know, people talking when they're having drinks.""
Patient: ""Yeah. Do you want it, like, do you kind of see it being outside? Is that something that you're interested in, outside shots?""
Therapist: ""Yeah, it's going to be a summer wedding, so we'd quite like a lot of outdoors shots, if possible, you know, if it's not raining, that would be quite nice. Yeah, quite some arty ones, if that's possible.""",483.23,507.2
005_053,005,53,1,"Yeah, yeah. And what kind of thing are you looking at? How do you want it to be like?","Therapist: ""Yeah, it's going to be a summer wedding, so we'd quite like a lot of outdoors shots, if possible, you know, if it's not raining, that would be quite nice. Yeah, quite some arty ones, if that's possible.""
Patient: ""Yeah, I've done quite a few things like that before. Have you got anything that you could show me about your past work? Yeah, I recently did some shoots outside, kind of in like a wood environment, so that I could show you that maybe it would kind of help with some ideas. Okay, great.""
Therapist: ""Right, let's do the second one now. Okay. Okay, you ready to put down the bottle and just to make eye contact? Okay. Hi, so I was just wondering if I could speak to you about doing my wedding photography?""",521.27,525.82
005_055,005,55,1,Okay. Are you interested in having things outside maybe? I know you said you wanted it to be natural.,"Therapist: ""Right, let's do the second one now. Okay. Okay, you ready to put down the bottle and just to make eye contact? Okay. Hi, so I was just wondering if I could speak to you about doing my wedding photography?""
Patient: ""Yeah, yeah. And what kind of thing are you looking at? How do you want it to be like?""
Therapist: ""I'd like kind of lots of shots of family and friends and quite a lot of natural shots, you know.""",534.69,541.22
005_057,005,57,1,"Yeah, actually, that's kind of a lot of the things I do are outside and I'm really interested in getting natural shots. So I could show you some of my work and we could kind of see if we could kind of develop something from that. Could be quite good.","Therapist: ""I'd like kind of lots of shots of family and friends and quite a lot of natural shots, you know.""
Patient: ""Okay. Are you interested in having things outside maybe? I know you said you wanted it to be natural.""
Therapist: ""yeah because it's going to be a summer wedding and okay you know weather dependent of course yeah it would be really great if we could kind of get lots of shots you know outdoors um okay yeah people chatting and and maybe some quite arty ones as well yeah have you got anything that you could show me about your past work""",557.04,572.02
005_061,005,61,1,"Definitely not as much as I thought. I think it's obvious that I'm obviously quite anxious, but I don't think you can tell I'm shaking that much.","Therapist: ""Okay, let's pause it there. Okay. Right, I'm just going to give you this back now to look at.""
Therapist: ""And I just want you to watch that. Okay. And then we'll just chat about it in a moment.""
Therapist: ""It's weird seeing it. So if we just go back to the things that you predicted, then you said that you thought you were going to shake, visibly shake. Could you see yourself shaking on the video?""",601.12,608.53
005_063,005,63,1,Maybe like less than 30.,"Therapist: ""It's weird seeing it. So if we just go back to the things that you predicted, then you said that you thought you were going to shake, visibly shake. Could you see yourself shaking on the video?""
Patient: ""Definitely not as much as I thought. I think it's obvious that I'm obviously quite anxious, but I don't think you can tell I'm shaking that much.""
Therapist: ""So you said that you were going to shake 90 out of 100. How much shaking would you say that you saw there in the end?""",616.71,619.09
005_065,005,65,1,"Not really. Actually, definitely less than I thought.","Therapist: ""So you said that you were going to shake 90 out of 100. How much shaking would you say that you saw there in the end?""
Patient: ""Maybe like less than 30.""
Therapist: ""Okay. You said that you were going to go red or pink, as pink as these chairs, 90 out of 100. Did you notice yourself going pink?""",632.77,635.98
005_069,005,69,1,Maybe like less than 10 maybe.,"Therapist: ""Yeah, not as much. Okay. You said that you were worried that you were going to say something stupid, 90 out of 100. Did you notice yourself say anything stupid?""
Patient: ""Not really.""
Therapist: ""Yeah, I thought it was going to be a lot worse than actually it was. So you thought you were going to be like 90, say something that was 90% stupid. That's really quite strong. I mean, in the end, did you pick up anything that, so could we maybe put that as a zero?""",665.74,668.84
005_071,005,71,1,Not really. Definitely not as bad as I thought.,"Therapist: ""Yeah, I thought it was going to be a lot worse than actually it was. So you thought you were going to be like 90, say something that was 90% stupid. That's really quite strong. I mean, in the end, did you pick up anything that, so could we maybe put that as a zero?""
Patient: ""Maybe like less than 10 maybe.""
Therapist: ""You said that you thought you were going to be sweating. Yeah. And that you were going to be visibly sweating. Did you, did you notice yourself sweating in the end?""",679.0,681.63
005_073,005,73,1,"Maybe, again, less than 10. I don't think you could tell at all.","Therapist: ""You said that you thought you were going to be sweating. Yeah. And that you were going to be visibly sweating. Did you, did you notice yourself sweating in the end?""
Patient: ""Not really. Definitely not as bad as I thought.""
Therapist: ""Again, you thought you were going to be like 90 out of 100, like seriously visibly sweating. So what score would you actually give it in the end?""",688.8,691.96
005_075,005,75,1,It was actually probably better when I wasn't doing any of those things. I think I looked a lot more natural and I was able to say what I was trying to say. I think I just come across more personable when I'm not kind of looking down and stuff.,"Therapist: ""Again, you thought you were going to be like 90 out of 100, like seriously visibly sweating. So what score would you actually give it in the end?""
Patient: ""Maybe, again, less than 10. I don't think you could tell at all.""
Therapist: ""You also said that you thought it was going to be twice as bad when you stopped using your normal strategies. Yeah. What did you notice watching that video?""",701.8,716.51
006_001,006,1,1,"Yeah, I've been fine. Been sticking to the plan, so it's been going well.","Therapist: ""Hi Jodie, nice to see you again. How have you been since I saw you last?""",24.72,29.73
006_003,006,3,2,"Yeah, it's been good. I've been trying to follow it, but last week wasn't very good. I had a bit of a bad day, but since then I've been fine, so it's okay.","Therapist: ""Hi Jodie, nice to see you again. How have you been since I saw you last?""
Patient: ""Yeah, I've been fine. Been sticking to the plan, so it's been going well.""
Therapist: ""Oh, the plan that the hospital set you? Yeah. Okay, fantastic. And how have you been finding that?""",35.16,45.79
006_005,006,5,2,I don't think I had anything.,"Therapist: ""Oh, the plan that the hospital set you? Yeah. Okay, fantastic. And how have you been finding that?""
Patient: ""Yeah, it's been good. I've been trying to follow it, but last week wasn't very good. I had a bit of a bad day, but since then I've been fine, so it's okay.""
Therapist: ""Okay, so tell me a bit more about that bad day. I mean, what did you eat on that day?""",52.23,55.11
006_009,006,9,4,It's been quite busy at school because we've got our exams and we had like a test the next day so I think I was just a bit like worried about that so I was trying to focus on that instead.,"Therapist: ""Okay, so you just ate nothing at all?""
Patient: ""Yeah.""
Therapist: ""Okay, I mean tell me a bit more about why was that day difficult? Was there anything that had been happening around that time?""",69.88,82.31
006_011,006,11,2,"No, I think we had sixth form applications due in and that was coming up in the next couple of days and I didn't really want to fill in my application for that.","Therapist: ""Okay, I mean tell me a bit more about why was that day difficult? Was there anything that had been happening around that time?""
Patient: ""It's been quite busy at school because we've got our exams and we had like a test the next day so I think I was just a bit like worried about that so I was trying to focus on that instead.""
Therapist: ""So you were feeling a bit anxious about the exam that was coming up. Was there anything else that was worrying you?""",89.55,106.39
006_014,006,14,2,"Probably the sixth form. Yeah, the sixth form one.","Patient: ""No, I think we had sixth form applications due in and that was coming up in the next couple of days and I didn't really want to fill in my application for that.""
Therapist: ""So it sounds like there was a couple of things that were worrying you that were on your mind.""
Therapist: ""Which thing was worrying you more, do you think?""",115.27,119.18
006_016,006,16,2,I don't really want to start sixth form yet.,"Therapist: ""Which thing was worrying you more, do you think?""
Patient: ""Probably the sixth form. Yeah, the sixth form one.""
Therapist: ""Okay. How did you feel about that? When we talk about that now and when that's brought up, what kind of emotions do you experience?""",129.57,132.25
006_017,006,17,2,"It's quite soon, but I don't really want to. I mean, I've got exams first, so I've got to think about those. But I don't really want to go to sixth form at the minute.","Patient: ""Probably the sixth form. Yeah, the sixth form one.""
Therapist: ""Okay. How did you feel about that? When we talk about that now and when that's brought up, what kind of emotions do you experience?""
Patient: ""I don't really want to start sixth form yet.""",134.04,143.27
006_019,006,19,2,"I have to start over again and make new friends and, like, a new routine and stuff, and I don't really feel ready for that yet.","Patient: ""I don't really want to start sixth form yet.""
Patient: ""It's quite soon, but I don't really want to. I mean, I've got exams first, so I've got to think about those. But I don't really want to go to sixth form at the minute.""
Therapist: ""OK, so what is it about sixth form that makes you not want to go?""",148.6,160.54
006_021,006,21,2,I don't know if anyone's going to like me. They might not want to talk to me and then I won't be able to focus on my work and get through it.,"Therapist: ""OK, so what is it about sixth form that makes you not want to go?""
Patient: ""I have to start over again and make new friends and, like, a new routine and stuff, and I don't really feel ready for that yet.""
Therapist: ""What do you think might happen when you have to make new friends and start a new routine?""",167.21,177.74
006_025,006,25,2,"A bit worried. I don't know what people are going to think, so I don't want to upset them and say anything wrong or do anything wrong.","Therapist: ""So you're worried that you might not be able to make friends?""
Therapist: ""And you might not be able to focus on the work?""
Therapist: ""And how do you feel when you have those thoughts?""",188.09,199.83
006_027,006,27,2,"It makes me feel a bit sick inside, having to talk to new people.","Therapist: ""And how do you feel when you have those thoughts?""
Patient: ""A bit worried. I don't know what people are going to think, so I don't want to upset them and say anything wrong or do anything wrong.""
Therapist: ""And I suppose I'm just trying to understand, because what you were just describing, that's more what I would think of as being a thought, worrying about what people might think and that people might think the wrong thing. And I suppose I'm wondering how you're feeling. You said you feel worried. Are there any other emotions that you feel about it?""",222.09,231.82
006_029,006,29,2,"I don't really think about them, I just try and ignore them and get on with what I need to do.","Therapist: ""And I suppose I'm just trying to understand, because what you were just describing, that's more what I would think of as being a thought, worrying about what people might think and that people might think the wrong thing. And I suppose I'm wondering how you're feeling. You said you feel worried. Are there any other emotions that you feel about it?""
Patient: ""It makes me feel a bit sick inside, having to talk to new people.""
Therapist: ""So you feel a bit worried and a bit sick. How easy is it for you to think about those kind of emotions and those feelings that you're describing?""",242.8,252.01
006_031,006,31,1,"No, I didn't feel worried that day. I was just trying to get on with my work and I actually felt a bit better that day.","Therapist: ""So you feel a bit worried and a bit sick. How easy is it for you to think about those kind of emotions and those feelings that you're describing?""
Patient: ""I don't really think about them, I just try and ignore them and get on with what I need to do.""
Therapist: ""Were you aware that you were feeling worried on the day that you stopped eating? Were you conscious that you were feeling anxious and worried?""",262.22,271.8
006_033,006,33,1,I didn't feel like I needed to because I didn't feel hungry. So I just wanted to do my work and then it made me feel better and I felt more focused on my work. So I thought I should carry on with that because I needed to revise.,"Therapist: ""Were you aware that you were feeling worried on the day that you stopped eating? Were you conscious that you were feeling anxious and worried?""
Patient: ""No, I didn't feel worried that day. I was just trying to get on with my work and I actually felt a bit better that day.""
Therapist: ""So why do you think that you turned to stopping eating? Because I mean, I suppose now that you're aware that you were feeling worried about sick form and about the exam, why do you think that you opted to stop eating on that day? What was it about that do you think that you thought might be helpful?""",294.77,314.87
006_035,006,35,1,"Yeah, I was more focused on the work I needed to do.","Therapist: ""So why do you think that you turned to stopping eating? Because I mean, I suppose now that you're aware that you were feeling worried about sick form and about the exam, why do you think that you opted to stop eating on that day? What was it about that do you think that you thought might be helpful?""
Patient: ""I didn't feel like I needed to because I didn't feel hungry. So I just wanted to do my work and then it made me feel better and I felt more focused on my work. So I thought I should carry on with that because I needed to revise.""
Therapist: ""So you thought it helped you to focus and you felt like it helped you. Do you feel like it did help you with the revision?""",324.5,327.22
006_039,006,39,2,"I think my father wanted me to, like my dad, he wanted me to focus on my work because of my exams. So I didn't want to like upset him and I thought I needed to do well in the test. So I was trying to do that.","Therapist: ""Okay, so you felt like it improved your focus as well?""
Patient: ""Yeah.""
Therapist: ""Okay, is there any other reasons why you think you might have turned to constricting your diet at that time?""",341.89,360.23
006_041,006,41,1,It seemed to be. I got more work done during the day because I didn't get distracted by anything. So I was revising all day and then the test went really well so it should be good. I should get a good mark for it.,"Therapist: ""Okay, is there any other reasons why you think you might have turned to constricting your diet at that time?""
Patient: ""I think my father wanted me to, like my dad, he wanted me to focus on my work because of my exams. So I didn't want to like upset him and I thought I needed to do well in the test. So I was trying to do that.""
Therapist: ""So you thought that by not eating you would help yourself to do better in the exam and kind of please your dad? Yeah. And do you think that it was helpful constricting your diet?""",373.75,389.61
006_043,006,43,4,I just don't want to upset my parents and make them feel like I'm a disappointment to them if I don't do well.,"Therapist: ""So you thought that by not eating you would help yourself to do better in the exam and kind of please your dad? Yeah. And do you think that it was helpful constricting your diet?""
Patient: ""It seemed to be. I got more work done during the day because I didn't get distracted by anything. So I was revising all day and then the test went really well so it should be good. I should get a good mark for it.""
Therapist: ""You seem like you may be getting a little bit anxious right now. I notice that you're shaking your leg. Is there anything that you're worried about right now?""",400.83,408.1
006_045,006,45,2,"Usually, because I don't want them to think they shouldn't have had me because I'm so worthless to them.","Therapist: ""You seem like you may be getting a little bit anxious right now. I notice that you're shaking your leg. Is there anything that you're worried about right now?""
Patient: ""I just don't want to upset my parents and make them feel like I'm a disappointment to them if I don't do well.""
Therapist: ""Okay, is that something that you're often worried about?""",413.48,420.89
006_047,006,47,2,"They'd probably say, like, as long as I do well, I'll be fine, like, and they'll love me if I do well in my exams and go to a good sixth form and get good grades.","Therapist: ""Okay, is that something that you're often worried about?""
Patient: ""Usually, because I don't want them to think they shouldn't have had me because I'm so worthless to them.""
Therapist: ""Okay, that's quite a heavy worry to be carrying, really. Have you talked to them about this worry? No, you haven't said it to them before. How do you think they might react if they did know that you felt this way?""",441.15,453.05
006_049,006,49,4,I don't see how they would want to if I was so worthless and useless at whatever I do.,"Therapist: ""Okay, that's quite a heavy worry to be carrying, really. Have you talked to them about this worry? No, you haven't said it to them before. How do you think they might react if they did know that you felt this way?""
Patient: ""They'd probably say, like, as long as I do well, I'll be fine, like, and they'll love me if I do well in my exams and go to a good sixth form and get good grades.""
Therapist: ""So you think that maybe they wouldn't love you if you didn't do well, go to a good sixth form?""",461.0,467.75
007_001,007,1,4,"Yeah, recently I'm just feeling down a lot and I can't really snap out of it. Sometimes if it's happened before I can just get myself back on track but recently I'm just finding it really difficult to do.","Therapist: ""Hi Gabriella, I understand that you're here today because you've been experiencing some low mood.""",20.56,34.01
007_005,007,5,2,"My long-term boyfriend broke up with me and it was such a shock, like I really wasn't expecting it and it just got me really down and I just felt really lonely. and I didn't really want to see people and she wanted to be in my own space and my mum told me I should probably go to the doctors and I went and he's referred me to you.","Therapist: ""Okay, so it sounds like you've been experiencing some low mood and you're kind of struggling to get going a bit.""
Patient: ""Yeah, yeah definitely.""
Therapist: ""You've had low mood in the past but it's kind of you've been able to pull yourself out of it before but more recently you found that harder. Okay. Okay, so I understand that you first went to your GP who referred you here about two months ago. Can I ask what led you to go to the GP in the first place?""",58.7,81.94
007_007,007,7,4,"I just, nothing's really changed, nothing's really improved, I just feel down, like everything's an effort and I just feel distant from things and like I said I can't snap out of it. Okay and how did you feel about coming here today? I was kind of disappointed in myself because I feel like nobody else my age is doing this. I should have been able to snap out of it. It's just another thing that I've not really... It's another thing that's making me stand out for the wrong reasons.","Therapist: ""You've had low mood in the past but it's kind of you've been able to pull yourself out of it before but more recently you found that harder. Okay. Okay, so I understand that you first went to your GP who referred you here about two months ago. Can I ask what led you to go to the GP in the first place?""
Patient: ""My long-term boyfriend broke up with me and it was such a shock, like I really wasn't expecting it and it just got me really down and I just felt really lonely. and I didn't really want to see people and she wanted to be in my own space and my mum told me I should probably go to the doctors and I went and he's referred me to you.""
Therapist: ""Okay so it sounds like you had that breakup and you weren't expecting it so it kind of came out of the blue a bit and that you've been on your own quite a lot so you've not been seeing people as much and it sounds like your mum noticed that there's been a bit of a change in you. Okay and how have things been then since then, since that happened and since you went to the GP?""",106.94,141.63
007_010,007,10,2,I'm just hoping that it's going to help. I think I didn't really want to admit it because it's just another failure. But my mum was talking to me and she's not really happy with the way I'm behaving and I don't really want to disappoint her again. so I thought there's no harm in it. So she thought I'd come.,"Patient: ""I just, nothing's really changed, nothing's really improved, I just feel down, like everything's an effort and I just feel distant from things and like I said I can't snap out of it. Okay and how did you feel about coming here today? I was kind of disappointed in myself because I feel like nobody else my age is doing this. I should have been able to snap out of it. It's just another thing that I've not really... It's another thing that's making me stand out for the wrong reasons.""
Therapist: ""Okay, so you feel like it's kind of odd or unusual to be coming to see a clinical psychologist. I suppose I just want to reassure you that it's absolutely normal to have feelings of depression and anxiety. It's really very common and it certainly isn't odd or strange at all. So it sounds like it was actually quite hard for you to come here today.""
Therapist: ""So what, I guess, led you to do that? Because it sounds like maybe there was a lot pushing you against coming here today, but you've managed to come anyway.""",170.49,194.71
007_013,007,13,2,"Yeah, I'm not currently in uni at the moment, but yeah, last year I was a medical student.","Patient: ""I'm just hoping that it's going to help. I think I didn't really want to admit it because it's just another failure. But my mum was talking to me and she's not really happy with the way I'm behaving and I don't really want to disappoint her again. so I thought there's no harm in it. So she thought I'd come.""
Therapist: ""So it sounds like partly you're doing it then for your mum because you're a bit worried that she isn't pleased with you at the moment.""
Therapist: ""Okay. Well, I think it's great that you've come here and definitely there's a lot of evidence to suggest that psychological therapy can help depression and particularly the type of therapy that we're going to be doing, which is called cognitive behaviour therapy. And I'll tell you a bit more about that as we go on. But I'm just trying to find out a bit more about you today. So I saw from your notes that you're a medic student.""",226.73,233.22
007_015,007,15,2,"It was a pretty tough first year, so they then suggested that I took a year out. This is the break.","Therapist: ""Okay. Well, I think it's great that you've come here and definitely there's a lot of evidence to suggest that psychological therapy can help depression and particularly the type of therapy that we're going to be doing, which is called cognitive behaviour therapy. And I'll tell you a bit more about that as we go on. But I'm just trying to find out a bit more about you today. So I saw from your notes that you're a medic student.""
Patient: ""Yeah, I'm not currently in uni at the moment, but yeah, last year I was a medical student.""
Therapist: ""Okay, so I guess why, what's the reason that you're not in uni this year?""",239.95,247.88
007_017,007,17,2,"Yeah, it was. I thought it's tough for everyone, but obviously we all take it in different ways, don't we? And you're planning on, are you planning on returning? Yeah, I'm going to have to really, so yeah. Don't sound too sure about that though. I think returning is probably, that's what's going to make everyone happy and I think at least I'll be able to finally achieve something and get something right. So yeah, next year I'm going to, I'll get through it, yeah.","Therapist: ""Okay, so I guess why, what's the reason that you're not in uni this year?""
Patient: ""It was a pretty tough first year, so they then suggested that I took a year out. This is the break.""
Therapist: ""Okay, so just thinking, so that would be about six months ago, was it, that your year out started? Yeah. And it sounds then maybe like your first year was also quite tough.""",259.97,294.47
007_019,007,19,4,I do. I do enjoy it. I just don't feel like me at the moment and it's a lot of work and it's a lot of pressure but that's what comes with it and it'll work out for the best if I go.,"Therapist: ""Okay, so just thinking, so that would be about six months ago, was it, that your year out started? Yeah. And it sounds then maybe like your first year was also quite tough.""
Patient: ""Yeah, it was. I thought it's tough for everyone, but obviously we all take it in different ways, don't we? And you're planning on, are you planning on returning? Yeah, I'm going to have to really, so yeah. Don't sound too sure about that though. I think returning is probably, that's what's going to make everyone happy and I think at least I'll be able to finally achieve something and get something right. So yeah, next year I'm going to, I'll get through it, yeah.""
Therapist: ""Okay, so it doesn't sound like you want to go back?""",297.23,314.95
007_021,007,21,2,"Well, I've not really had much on the horizon. My mum, her friend owns a restaurant and she suggested that I did a bit of waitressing there, just for a bit of money and stuff, because obviously I'm not in uni. So, you know, I've done that. Okay. How many shifts have you done there? I've only done one so far. Yeah, I don't know whether it's something that I'd probably go back to. Okay, when was that shift?","Therapist: ""Okay, so it doesn't sound like you want to go back?""
Patient: ""I do. I do enjoy it. I just don't feel like me at the moment and it's a lot of work and it's a lot of pressure but that's what comes with it and it'll work out for the best if I go.""
Therapist: ""Okay, so I guess then there's quite a lot of thoughts and feelings about going back at the moment. I'm just wondering in the meantime what are you up to, what have you been doing?""",328.17,361.24
007_023,007,23,2,"It was different, you know, because it was like I could... I did enjoy it because it's just a different aspect and I had to speak to people and try to get their orders and try to remember it and stuff. I wasn't very good but I suppose it was handy to have some money and get out the house.","Therapist: ""Okay, so I guess then there's quite a lot of thoughts and feelings about going back at the moment. I'm just wondering in the meantime what are you up to, what have you been doing?""
Patient: ""Well, I've not really had much on the horizon. My mum, her friend owns a restaurant and she suggested that I did a bit of waitressing there, just for a bit of money and stuff, because obviously I'm not in uni. So, you know, I've done that. Okay. How many shifts have you done there? I've only done one so far. Yeah, I don't know whether it's something that I'd probably go back to. Okay, when was that shift?""
Therapist: ""It was last week, actually. Okay, and how was it? I suppose I'm intrigued. Can you tell me a bit more about that?""",367.48,392.5
007_026,007,26,4,"I was just a bit slow and people sometimes they didn't understand what I was saying so I'd have to talk louder or quieter or slower and I got a bit confused sometimes with the orders and I just don't really think that I'm not really like a friendly person. People don't really think that I'm a friendly person, so they didn't really want to talk to me and stuff. I felt like I was inconveniencing them by asking them things and getting things wrong. They said that apparently most people get a few mistakes on their first shift. But then again, she's my mum's friend, so... probably why she's saying it.","Patient: ""It was different, you know, because it was like I could... I did enjoy it because it's just a different aspect and I had to speak to people and try to get their orders and try to remember it and stuff. I wasn't very good but I suppose it was handy to have some money and get out the house.""
Therapist: ""So it sounds like you quite enjoyed that then?""
Therapist: ""What makes you think you weren't very good?""",398.71,443.22
007_028,007,28,4,"That's what she said to us. But, um, But it's probably just she's just trying to make me feel better. She probably felt sorry for me because I'm obviously not very good at it. Like, I'm not very good at any things recently. I think she just felt sorry for me.","Therapist: ""What makes you think you weren't very good?""
Patient: ""I was just a bit slow and people sometimes they didn't understand what I was saying so I'd have to talk louder or quieter or slower and I got a bit confused sometimes with the orders and I just don't really think that I'm not really like a friendly person. People don't really think that I'm a friendly person, so they didn't really want to talk to me and stuff. I felt like I was inconveniencing them by asking them things and getting things wrong. They said that apparently most people get a few mistakes on their first shift. But then again, she's my mum's friend, so... probably why she's saying it.""
Therapist: ""So the person who owns the restaurant is your mum's friend. Yeah. Um, okay. So it says you, you're saying that you think you weren't very good and that's because you were a bit slow and you got confused with some orders. Yeah. Is it, but you said it's common for people to do that on their first shift.""",457.79,475.06
007_030,007,30,2,"Well, like I said, she's my mum's friend She's obviously feeling sorry for my mum as well because she's got a daughter that's not like anyone else of her age. And she's just like all alone and she's not getting involved. So I think she just feels sorry for me and she doesn't want to say anything to upset me.","Therapist: ""So the person who owns the restaurant is your mum's friend. Yeah. Um, okay. So it says you, you're saying that you think you weren't very good and that's because you were a bit slow and you got confused with some orders. Yeah. Is it, but you said it's common for people to do that on their first shift.""
Patient: ""That's what she said to us. But, um, But it's probably just she's just trying to make me feel better. She probably felt sorry for me because I'm obviously not very good at it. Like, I'm not very good at any things recently. I think she just felt sorry for me.""
Therapist: ""Okay, so I've just been noting down some of those thoughts that you've been having. You kind of say that you feel like you're not very good, you're slow, you're confused with the orders and you feel like you're inconveniencing her and she feels sorry for you. I suppose I'm wondering, I mean, what makes you think that she feels sorry for you?""",492.94,511.5
007_032,007,32,1,"I don't. I'm just calling it as it is, I'm just calling it as reality and I feel like I'm being honest with myself by just voicing it and not trying to go around hiding it because I know I can see it in myself.","Therapist: ""Okay, so I've just been noting down some of those thoughts that you've been having. You kind of say that you feel like you're not very good, you're slow, you're confused with the orders and you feel like you're inconveniencing her and she feels sorry for you. I suppose I'm wondering, I mean, what makes you think that she feels sorry for you?""
Patient: ""Well, like I said, she's my mum's friend She's obviously feeling sorry for my mum as well because she's got a daughter that's not like anyone else of her age. And she's just like all alone and she's not getting involved. So I think she just feels sorry for me and she doesn't want to say anything to upset me.""
Therapist: ""When you're having these kind of thoughts, because that's quite a lot of negative thoughts you're describing, how do you feel? I just feel empty.""",523.22,544.06
007_036,007,36,3,"I just feel distant and like I said I'm not really myself, I just... It's like I'm not really there but when I am I can't even do a good job. Are there any other emotions that you experience? I feel drained. I don't feel like I'm in touch with anything. It's like everything's going on around me but I'm just not there. It's like I'm just watching.","Therapist: ""So it sounds like you feel like those thoughts are very true then? I mean if you were going to rate them, say I'm going to pick out some of those thoughts you described, so you said I'm not very good and I'm inconveniencing them, how much would you say you believe those on a scale out of 100? Where 100 is like I absolutely believe it and zero is like I don't believe it at all.""
Patient: ""About 80.""
Therapist: ""So you feel quite sure that you definitely believe those? And he said that when you're thinking those thoughts you start to feel quite empty.""",580.48,610.56
007_038,007,38,2,"I don't know how to describe it. I have a bit of like, You know when you kind of get butterflies when you're nervous and stuff, you kind of get a bit of that. Do you feel some butterflies? Yeah.","Therapist: ""So you feel quite sure that you definitely believe those? And he said that when you're thinking those thoughts you start to feel quite empty.""
Patient: ""I just feel distant and like I said I'm not really myself, I just... It's like I'm not really there but when I am I can't even do a good job. Are there any other emotions that you experience? I feel drained. I don't feel like I'm in touch with anything. It's like everything's going on around me but I'm just not there. It's like I'm just watching.""
Therapist: ""Okay, so you feel empty, distant. You feel drained. And how... When you're feeling these emotions, how do you feel in your body? What sensations do you notice?""",628.15,640.86
007_040,007,40,2,"Yeah, I was pretty nervous then but when I got into it they went away and it distracted me for a bit until obviously I realised that I wasn't doing a very good job.","Therapist: ""Okay, so you feel empty, distant. You feel drained. And how... When you're feeling these emotions, how do you feel in your body? What sensations do you notice?""
Patient: ""I don't know how to describe it. I have a bit of like, You know when you kind of get butterflies when you're nervous and stuff, you kind of get a bit of that. Do you feel some butterflies? Yeah.""
Therapist: ""Did you have butterflies that night when you were at the restaurant?""",644.68,657.76
007_042,007,42,5,I just feel drained. I don't even have the energy to wake up in the morning sometimes. I just feel pointless. My body's heavy and I don't want to... Yeah.,"Therapist: ""Did you have butterflies that night when you were at the restaurant?""
Patient: ""Yeah, I was pretty nervous then but when I got into it they went away and it distracted me for a bit until obviously I realised that I wasn't doing a very good job.""
Therapist: ""Okay, and when you have those emotions, how does it affect your energy levels? Do you feel more energetic, less energetic, or about the same? When I'm feeling down? Yeah, when you're having those emotions that you were describing.""",673.62,686.05
007_044,007,44,2,"I just have to get up I suppose, I don't really have a choice because I live with my mum and I know it's hard for her so I don't want her to be too worried so I just try to carry on as normal and get up. It takes longer and I don't want to but I do so I get on with my routine.","Therapist: ""Okay, and when you have those emotions, how does it affect your energy levels? Do you feel more energetic, less energetic, or about the same? When I'm feeling down? Yeah, when you're having those emotions that you were describing.""
Patient: ""I just feel drained. I don't even have the energy to wake up in the morning sometimes. I just feel pointless. My body's heavy and I don't want to... Yeah.""
Therapist: ""Sounds like you feel very tired. You're struggling to wake up. You said it's pointless. And what do you do then when you feel like that? So I guess you just talked about when you wake up in the morning and you feel heavy. And I suppose you've been maybe having some of these thoughts and those emotions potentially the night before. What do you then do? How do you respond to that?""",710.79,734.95
007_046,007,46,2,"I'm just thinking that nobody else is like me. It's my age, like, nobody should be feeling like this. And I'm the only one that does.","Therapist: ""Sounds like you feel very tired. You're struggling to wake up. You said it's pointless. And what do you do then when you feel like that? So I guess you just talked about when you wake up in the morning and you feel heavy. And I suppose you've been maybe having some of these thoughts and those emotions potentially the night before. What do you then do? How do you respond to that?""
Patient: ""I just have to get up I suppose, I don't really have a choice because I live with my mum and I know it's hard for her so I don't want her to be too worried so I just try to carry on as normal and get up. It takes longer and I don't want to but I do so I get on with my routine.""
Therapist: ""So you're a bit slower in getting up? but you are still getting up anyway. And what about your kind of, what do you think about when you're doing that?""",745.28,755.87
007_048,007,48,4,"I don't want to feel like this, but I do. and nobody else I know does so it makes me feel even more alone and that gets me even more down and I just don't want to disappoint anyone and I just don't really want it.","Therapist: ""So you're a bit slower in getting up? but you are still getting up anyway. And what about your kind of, what do you think about when you're doing that?""
Patient: ""I'm just thinking that nobody else is like me. It's my age, like, nobody should be feeling like this. And I'm the only one that does.""
Therapist: ""So it sounds like you think a bit more about the problem and you kind of spend time thinking about how you're feeling. I hate having it.""",763.3,779.97
007_051,007,51,4,It feels worse because I still can't snap out of it. I'm aware it's happening and I'm trying but I just can't. And then it's just another thing that I'm failing at. It's just another thing that I can't really get.,"Patient: ""I don't want to feel like this, but I do. and nobody else I know does so it makes me feel even more alone and that gets me even more down and I just don't want to disappoint anyone and I just don't really want it.""
Therapist: ""Okay so it sounds like you try and toughen up on yourself a little bit, tell yourself to work harder, to be different.""
Therapist: ""Okay and when you start telling yourself that kind of thing and how does that make you feel? Does that make you feel better afterwards or worse?""",797.23,817.57
008_003,008,3,4,"It's still the same. Nothing at home is going right. I'm still yelling, we're still fighting.","Therapist: ""Hi Liz, how are you doing today?""
Patient: ""I'm alright, how are you?""
Therapist: ""I'm doing well, thanks for asking. What's been going on in the last week?""",23.73,30.98
008_005,008,5,5,"Yeah, he just can't get it together. He doesn't do anything right. And I just end up screaming every day. And it takes it all out of me.","Therapist: ""I'm doing well, thanks for asking. What's been going on in the last week?""
Patient: ""It's still the same. Nothing at home is going right. I'm still yelling, we're still fighting.""
Therapist: ""You and your boyfriend?""",33.7,44.55
008_007,008,7,4,Yeah.,"Therapist: ""You and your boyfriend?""
Patient: ""Yeah, he just can't get it together. He doesn't do anything right. And I just end up screaming every day. And it takes it all out of me.""
Therapist: ""All right, so he can't do anything right, and you're arguing, being angry every day.""",54.35,57.41
008_009,008,9,5,"I feel like he does nothing wrong, and I end up screaming at him when I come home from work, and that's a lot out of me every day, and I don't want to feel angry every single day.","Therapist: ""All right, so he can't do anything right, and you're arguing, being angry every day.""
Patient: ""Yeah.""
Therapist: ""So what are you taking away from this? Like, what do you think's going on?""",62.84,75.03
008_012,008,12,5,"It's anything. It's, I come home, he's just sitting on the couch, I've had a long day at work, he gets home work before me, and the dishes aren't done, nothing's like thought or even started for dinner, and is that just supposed to be my, like it's not, he could just do one thing. And I just, I just lose it. I lose it. And I can't, I can't control it. I just start screaming at him that he does nothing, that he could just do one thing for me. He could just have the sink clean, empty. One thing. And it, every single day. And then the next day it's something else. The trash is now. Like, you name it.","Patient: ""I feel like he does nothing wrong, and I end up screaming at him when I come home from work, and that's a lot out of me every day, and I don't want to feel angry every single day.""
Therapist: ""That's what's happening.""
Therapist: ""What types of things do you think are triggering your anger response?""",85.32,123.34
008_014,008,14,4,um yelling yeah what's his um response to this like what's he do when when you yell out he gets mad back he just starts screaming back at me like i expect too much and i get too upset and why am i always yelling at him why can't i give him the benefit of the doubt but i don't understand it like you could do one thing and then and i just i can't help it i scream at him,"Therapist: ""What types of things do you think are triggering your anger response?""
Patient: ""It's anything. It's, I come home, he's just sitting on the couch, I've had a long day at work, he gets home work before me, and the dishes aren't done, nothing's like thought or even started for dinner, and is that just supposed to be my, like it's not, he could just do one thing. And I just, I just lose it. I lose it. And I can't, I can't control it. I just start screaming at him that he does nothing, that he could just do one thing for me. He could just have the sink clean, empty. One thing. And it, every single day. And then the next day it's something else. The trash is now. Like, you name it.""
Therapist: ""So every, every day when you come home from work, there's something he's done or failed to do that triggers...""",133.87,161.24
008_016,008,16,2,"I mean on anniversaries, he'll make dinner. So that's nice. Okay. He makes good money. So that's, he keeps that together. Okay.","Therapist: ""So every, every day when you come home from work, there's something he's done or failed to do that triggers...""
Patient: ""um yelling yeah what's his um response to this like what's he do when when you yell out he gets mad back he just starts screaming back at me like i expect too much and i get too upset and why am i always yelling at him why can't i give him the benefit of the doubt but i don't understand it like you could do one thing and then and i just i can't help it i scream at him""
Therapist: ""Are there other things he does, other times that you feel are helpful? Or is it always, like when you come home, is it always something that hasn't been done right or hasn't been done?""",177.83,190.82
008_017,008,17,4,"Yeah, the rest is just... I just get angry at him.","Patient: ""um yelling yeah what's his um response to this like what's he do when when you yell out he gets mad back he just starts screaming back at me like i expect too much and i get too upset and why am i always yelling at him why can't i give him the benefit of the doubt but i don't understand it like you could do one thing and then and i just i can't help it i scream at him""
Therapist: ""Are there other things he does, other times that you feel are helpful? Or is it always, like when you come home, is it always something that hasn't been done right or hasn't been done?""
Patient: ""I mean on anniversaries, he'll make dinner. So that's nice. Okay. He makes good money. So that's, he keeps that together. Okay.""",191.56,197.03
008_019,008,19,4,"Stubborn, condescending, and intelligent.","Patient: ""I mean on anniversaries, he'll make dinner. So that's nice. Okay. He makes good money. So that's, he keeps that together. Okay.""
Patient: ""Yeah, the rest is just... I just get angry at him.""
Therapist: ""So if you were to pick adjectives to describe him, what adjectives might you select?""",208.69,219.66
008_021,008,21,2,"I don't think it's all the time. Like, a month ago when a friend at work died, old age, whatever, but I had a long day. He knew it beforehand. I didn't have to say anything. When I came home, everything was good. There was no trash, no dishes. So it's not all the time, but just lately it's just, I have no words.","Therapist: ""So if you were to pick adjectives to describe him, what adjectives might you select?""
Patient: ""Stubborn, condescending, and intelligent.""
Therapist: ""And intelligent. All right. Stubborn, condescending, and intelligent. Do you see him as this way kind of all the time, or is this change?""",233.9,264.08
008_024,008,24,2,Yeah.,"Patient: ""I don't think it's all the time. Like, a month ago when a friend at work died, old age, whatever, but I had a long day. He knew it beforehand. I didn't have to say anything. When I came home, everything was good. There was no trash, no dishes. So it's not all the time, but just lately it's just, I have no words.""
Therapist: ""So lately it's all the time.""
Therapist: ""But there's been prior occasions when this hasn't been a problem.""",271.83,274.21
008_026,008,26,4,"I'm still irritable. Like, the dishes don't even get done. The problem didn't go away. It didn't fix itself while I was yelling. So it just, it sucks. Being that angry just doesn't, I hate it.","Therapist: ""But there's been prior occasions when this hasn't been a problem.""
Patient: ""Yeah.""
Therapist: ""But there's not many of those. Yeah. All right. So after you have... You know, you yell and argue. What's it feel like to you then? Like, what's your mood?""",287.81,301.78
008_030,008,30,4,"Like I said, I just lose it. And I do that because that's what it feels like.","Therapist: ""So it's not productive for you.""
Patient: ""Right, right. It's not productive.""
Therapist: ""But there's a part you mentioned earlier where, like you said, you just can't help yourself.""",313.03,317.04
008_032,008,32,5,"I just, I go off. Why didn't you do the dishes? You've been home an hour and a half. You could have done one thing for me. I had a longer day and you knew it.","Therapist: ""But there's a part you mentioned earlier where, like you said, you just can't help yourself.""
Patient: ""Like I said, I just lose it. And I do that because that's what it feels like.""
Therapist: ""So it's like you just see, for example, like the dishes. Right. So you just see the dishes aren't done and immediately there's the...""",328.11,335.68
008_038,008,38,4,"I get pissed, but I just, I can't yell.","Therapist: ""So there's times you kind of have that moment with them where you just can't believe they didn't do something?""
Patient: ""Yeah, I just can't stand them sometimes.""
Therapist: ""And what's your reaction in terms of anger? and yelling to those events.""",370.83,373.35
008_043,008,43,4,"Oh, if not more. Because I actually choose to be with my boyfriend. I don't choose to be with those people necessarily.","Therapist: ""And why's that?""
Patient: ""I get fired.""
Therapist: ""You get fired. So in those interactions with your coworkers, would it be fair to say you're in that moment just as angry as you are with your boyfriend?""",388.71,395.49
008_049,008,49,1,"Right, they wouldn't know or react. There's no response.","Therapist: ""So they don't really know you're angry?""
Patient: ""walk away, I don't think they'd be able to tell.""
Therapist: ""And they're not being yelled at, so they're not...""",432.41,435.84
008_051,008,51,2,"Yeah, there must Yeah.","Therapist: ""And they're not being yelled at, so they're not...""
Patient: ""Right, they wouldn't know or react. There's no response.""
Therapist: ""No reaction, right. So, there is a thought process that occurs between the trigger and when you act. Because at work, you're thinking, you have this thought that comes up, I don't want to be fired.""",455.06,457.65
008_053,008,53,3,"Right, I can't act angry or I'll get fired and I don't want to get fired, I guess.","Therapist: ""No reaction, right. So, there is a thought process that occurs between the trigger and when you act. Because at work, you're thinking, you have this thought that comes up, I don't want to be fired.""
Patient: ""Yeah, there must Yeah.""
Therapist: ""And the consequence of that thought is, I'll be angry, but I'm not going to act angry.""",464.92,468.3
008_055,008,55,4,"I mean, just that he never does anything right.","Therapist: ""And the consequence of that thought is, I'll be angry, but I'm not going to act angry.""
Patient: ""Right, I can't act angry or I'll get fired and I don't want to get fired, I guess.""
Therapist: ""So, knowing that there is a thought there, when you come home and you see the dishes aren't done, let me just stay with that example. What would that thought be? Think back to the last time that happened. Do you remember that you were thinking at that moment, as you saw those dishes sitting there not washed?""",492.59,495.94
008_058,008,58,2,"Yeah, I guess there's a thought where I'm sitting there and I'm looking at him, thinking about him, saying, you never do anything right.","Patient: ""I mean, just that he never does anything right.""
Therapist: ""He never does anything right. All right. So you see the dishes not washed. He never does anything right. That's the thought. Yeah. And then the reaction, the behavior, is finding him and yelling at him.""
Therapist: ""Hmm. Alright, so you see how there is an intervening thought between the trigger, which in this case the dishes, and the behavior, which is the yelling.""",524.78,530.9
008_061,008,61,4,"Oh, it's absolute tunnel vision at that point.","Patient: ""Yeah, I guess there's a thought where I'm sitting there and I'm looking at him, thinking about him, saying, you never do anything right.""
Therapist: ""So remember we talked a few weeks ago about cognitive distortions, where we talked about like the errors, like consistent, there are consistent errors in thinking, right? And I'm wondering, if that thought, he never does anything right, if that's similar to or matches up with any of the cognitive distortions we talked about. Okay. And I'm wondering if it's not, if it's not kind of blocking off your path in terms of thinking, right? So you're saying he never does anything right.""
Therapist: ""So it's kind of like maybe a kind of all or nothing thinking that we talked about.""",572.25,574.42
008_064,008,64,2,"Yeah, there are occasions where he must have thought about me.","Patient: ""Oh, it's absolute tunnel vision at that point.""
Therapist: ""Tunnel vision?""
Therapist: ""So a few different distortions at work. But you mentioned earlier, there are times when he does do things right.""",584.5,591.53
008_070,008,70,2,Maybe that he has done something right in the past. Okay. So it's bound to happen again. It is possible.,"Therapist: ""Okay, more considerate. So, the statement he never does the thought, he never does anything right, that could be challenged.""
Patient: ""Yeah, I guess technically it could.""
Therapist: ""And what might be, as an alternative to the behavior, right, to the yelling, instead of doing that, what might be a thought that you could kind of insert right after that he never does anything right thought that might change the outcome for you, that might disrupt that connection between that thought and your yelling?""",639.74,648.42
008_073,008,73,2,"The dishes don't get done. After that. And the next day, I might still find the dishes there. It doesn't...","Patient: ""Maybe that he has done something right in the past. Okay. So it's bound to happen again. It is possible.""
Therapist: ""All right. So an adaptive response, as we call them, right, self-talk, that says he's not altogether bad because he has done things right in the past.""
Therapist: ""Right. Which is a little more flexible in thinking than thinking he, than your automatic thought, which is he never does. That's your automatic thought. He never does anything right. So a little bit more flexibility in the thinking might get you to a place where you're not yelling. And then on the other side of it too, I'm wondering if we can't challenge the usefulness of yelling. You mentioned that you've done it quite a bit, but you're not really getting a different result.""",695.53,703.18
008_079,008,79,2,"I've had previous boyfriends where this was a problem, and that relationship has long gone because of it.","Therapist: ""So, when you're yelling, there's an expression of emotion, but there's also this hope that the yelling will change his behavior.""
Patient: ""Right, something.""
Therapist: ""But it's not. Nope. And what was the first time in terms of, like, how long ago this was a problem?""",727.64,736.09
008_081,008,81,2,"Due to the yelling. So I don't... I really do like this guy who's not all bad, and I don't want my yelling to be a problem, my anger. But it...","Therapist: ""But it's not. Nope. And what was the first time in terms of, like, how long ago this was a problem?""
Patient: ""I've had previous boyfriends where this was a problem, and that relationship has long gone because of it.""
Therapist: ""So, due to the yelling and the fighting?""",738.71,751.93
008_085,008,85,4,It feels like that's what I'm supposed to be doing and that's what I do.,"Therapist: ""But it's hard to control for you. You're struggling with the anger.""
Therapist: ""And the yelling.""
Therapist: ""Rationally, you understand it doesn't work, like it's not getting what you want. But somehow it feels like a release, it feels like justice, it feels good to be able to...""",770.11,772.65
008_087,008,87,2,"Protected, that's a great word. I guess walking away is what I do at the office.","Therapist: ""Rationally, you understand it doesn't work, like it's not getting what you want. But somehow it feels like a release, it feels like justice, it feels good to be able to...""
Patient: ""It feels like that's what I'm supposed to be doing and that's what I do.""
Therapist: ""It's what you're supposed to be doing, okay? So it feels like it's what you're supposed to be doing. Do you have an idea of what might be a more productive path for you as an alternative to the yelling?""",788.37,794.9
008_089,008,89,1,I've been able to take a minute and either remove myself or intervene my opinion more calmly because I haven't yelled at work. So I guess walking away and taking a minute.,"Therapist: ""It's what you're supposed to be doing, okay? So it feels like it's what you're supposed to be doing. Do you have an idea of what might be a more productive path for you as an alternative to the yelling?""
Patient: ""Protected, that's a great word. I guess walking away is what I do at the office.""
Therapist: ""And that has worked for you.""",797.26,813.34
008_091,008,91,1,"Mean honestly if I'm by myself like five minutes ten minutes of just me time, so let's even say ten minutes Yeah, so ten minutes and then you can respond","Therapist: ""And that has worked for you.""
Patient: ""I've been able to take a minute and either remove myself or intervene my opinion more calmly because I haven't yelled at work. So I guess walking away and taking a minute.""
Therapist: ""Okay, so that would be one. Behavioral strategy, right? So you you you see the trigger? Mm-hmm, and you have the thought it never does anything, right and then you could intervene with a thought of I need to walk away and a behavior of walking away and Taking like how much time I?""",837.07,846.92
008_093,008,93,2,"Right. At what point in the day, when who is working when, being considerate of the other.","Therapist: ""Okay, so that would be one. Behavioral strategy, right? So you you you see the trigger? Mm-hmm, and you have the thought it never does anything, right and then you could intervene with a thought of I need to walk away and a behavior of walking away and Taking like how much time I?""
Patient: ""Mean honestly if I'm by myself like five minutes ten minutes of just me time, so let's even say ten minutes Yeah, so ten minutes and then you can respond""
Therapist: ""more constructively, more usefully. To what is, you know, a type of relational disagreement, right? You have a disagreement over, it sounds like, who should be doing what.""",861.93,866.4
008_097,008,97,4,"Oh, yeah, we have not worked out. It hasn't helped.","Therapist: ""And that, that's certainly worth talking about. I mean, that makes sense that you guys would talk through that. But it seems like the yelling, I mean, you're just going right to the yelling.""
Patient: ""We're not getting anywhere.""
Therapist: ""Right, so there's not really any time to address the issue.""",886.61,889.86
008_101,008,101,2,"I didn't think that there was anything between me seeing the dishes and yelling at him. I knew that the anger wasn't getting me anywhere, but I didn't think I, but I guess there is a moment in between because I don't always yell. Like I don't yell at work. So there is something else I could do.","Therapist: ""So the yelling is really an impediment to what you want to achieve with the yelling.""
Patient: ""Yeah, I guess.""
Therapist: ""Right? In a manner of speaking, it's blocking your goal. So do you kind of recognize that? Like, are you seeing how?""",906.68,930.18
008_105,008,105,1,"Yeah, there's a sliver that I must see at work that is also there at home.","Therapist: ""Right. So, so if I'm hearing you right, there's a sensation that it's kind of reflexive. Like you see the dishes and automatically you go right to the next.""
Patient: ""It immediately feels like I'm yelling.""
Therapist: ""But in actuality, now you're realizing that there's a gap, even if it's small, there's a gap where thinking takes place.""",951.4,958.57
008_107,008,107,4,"Oh, I can definitely say it's been a thought when I'm driving home. I'm like, it's been a long day. It was a long day at the office. And I know he's not going to have the trash taken out like I asked him or the dishes done or the chicken thawed, anything.","Therapist: ""But in actuality, now you're realizing that there's a gap, even if it's small, there's a gap where thinking takes place.""
Patient: ""Yeah, there's a sliver that I must see at work that is also there at home.""
Therapist: ""And I'm wondering, too, that there's a sense that... I mean, there's a sense that the rules of the relationship are being violated. You come home and a part of you might know that's going to happen. Like you come in, you know you might see that this is not done or some other chore not done. So I'm wondering if you think about it in advance, kind of try to inoculate yourself, so to speak.""",988.95,1002.32
008_115,008,115,1,It does. It does. It's like one more non-productive piece of it that I could change.,"Therapist: ""So that way when you see it, it's not such a shock. It doesn't feel like such a reflex to go right to the anger.""
Patient: ""Yeah.""
Therapist: ""Does that make sense?""",1063.24,1070.49
008_117,008,117,1,"And just start myself off by thinking, he's not all bad. There could be something there, but it'll be okay. Like I can just take a minute to myself.","Therapist: ""Does that make sense?""
Patient: ""It does. It does. It's like one more non-productive piece of it that I could change.""
Therapist: ""Yeah, that's within your power to change. And it could be something very good for you. So now it might be working against you, the thoughts in advance of when you come home, but you could have those thoughts working for you.""",1084.86,1094.3
008_126,008,126,1,It does. It does.,"Therapist: ""Where I want you to just kind of read it over this time, and we'll talk about it in more detail next time. Okay. But it's an opportunity to record your thoughts, like a trigger, and your thoughts, and kind of what happened, and then there's a place for adaptive responses. But we'll go through it step by step. I'm just going to give it to you today so you can look at it. Okay. And familiarize yourself with the format. It all fits on one page. Okay. All right. And what I'm going to ask you to do in the future is to complete these thought records when you have a thought that ends up with a behavior, whether it's a desirable or undesirable outcome. Okay. We're going to see what the process is and then how well the adaptive responses are working. Because we may have to adjust them a bit over time.""
Patient: ""Okay.""
Therapist: ""Does that more or less make sense?""",1220.17,1222.35
009_000,009,0,2,"Hi Elizabeth, how are you doing today? I'm alright.",(Beginning of session — no prior context),14.89,16.93
009_002,009,2,4,"It's about the same. I'm still feeling pretty down. I mean, I just feel really stuck and not happy and I just don't know why.","Patient: ""Hi Elizabeth, how are you doing today? I'm alright.""
Therapist: ""How have things been going since the last time we met?""",20.84,31.09
009_004,009,4,4,"I mean, I've been feeling, like, really isolated lately. You know, because I'm a stay-at-home mom, it's hard. There's not a lot of people, you know, right at my fingertips to spend my time with. You know, obviously my family, but... So, I guess, you know, I kind of, I had some friends in the neighborhood. But our friendships just kind of fizzled out. And ever since then, it's just like I don't really feel like doing much. I just kind of feel like what's the point and let my husband take care of a lot of stuff. I used to shop for the groceries all the time and make sure the house is always stocked and make dinner every night and get the kids ready for school in the morning. And I still do that stuff, but a lot of times, You know, I let it slide. Sometimes I won't make dinner or whatever. And when I do do it, I just feel like I'm forcing myself to do it. The passion is gone.","Therapist: ""How have things been going since the last time we met?""
Patient: ""It's about the same. I'm still feeling pretty down. I mean, I just feel really stuck and not happy and I just don't know why.""
Therapist: ""Okay, so there's a few things going on there. You said you're feeling stuck, not happy, and you sound like you're a little confused as to what's going on, what's causing it. Do you have any suspicions about what might be causing it?""",50.67,112.19
009_006,009,6,1,"Um, for a long time. I have two boys, they're eight and ten, and I've been staying home since my first one was born, so ten years, and you know, it's been really rewarding for me. I'm not really interested in going back to work or anything like that, um, because I know people always say, you know, you're feeling, um, unfulfilled, like you should go back to work, but it's not, you know, I've felt happy with it for so long. I don't think that it's, Being home, I think it's something inside of me.","Therapist: ""Okay, so there's a few things going on there. You said you're feeling stuck, not happy, and you sound like you're a little confused as to what's going on, what's causing it. Do you have any suspicions about what might be causing it?""
Patient: ""I mean, I've been feeling, like, really isolated lately. You know, because I'm a stay-at-home mom, it's hard. There's not a lot of people, you know, right at my fingertips to spend my time with. You know, obviously my family, but... So, I guess, you know, I kind of, I had some friends in the neighborhood. But our friendships just kind of fizzled out. And ever since then, it's just like I don't really feel like doing much. I just kind of feel like what's the point and let my husband take care of a lot of stuff. I used to shop for the groceries all the time and make sure the house is always stocked and make dinner every night and get the kids ready for school in the morning. And I still do that stuff, but a lot of times, You know, I let it slide. Sometimes I won't make dinner or whatever. And when I do do it, I just feel like I'm forcing myself to do it. The passion is gone.""
Therapist: ""And how long have you been, you say housewife, right? How long have you been a housewife?""",124.07,155.79
009_008,009,8,4,"Yeah. Exactly. Well, I guess, you know, my youngest is eight, so he's only been in school for a couple of years, so I guess, like, it's not super recent, but recently he, I finally have no children in the home, so it's more, it's more time to myself. and I kind of filled that gap a little bit with other things like I did Cub Scouts with the boys for a while and like I said I had some friends around the neighborhood so that kind of like filled that time but now that stuff it's just not really happening anymore so now I kind of feel like it's not it's not boredom you know it's not like I don't have enough to do it's like I don't want to do anything but then at the same time I feel frustrated because there's nothing to do","Therapist: ""And how long have you been, you say housewife, right? How long have you been a housewife?""
Patient: ""Um, for a long time. I have two boys, they're eight and ten, and I've been staying home since my first one was born, so ten years, and you know, it's been really rewarding for me. I'm not really interested in going back to work or anything like that, um, because I know people always say, you know, you're feeling, um, unfulfilled, like you should go back to work, but it's not, you know, I've felt happy with it for so long. I don't think that it's, Being home, I think it's something inside of me.""
Therapist: ""Something's changed. So for a long time, you were satisfied being a housewife. You enjoyed that life or found satisfaction in that life. And somewhere along the line, something changed in you. And now you're not happy with it. Yeah. So what it represents in terms of activities, like caring for your children and shopping, none of that's really changed.""",181.41,229.57
009_010,009,10,3,"Yeah, I think a lot more with myself because I know that I would feel better if I, you know, maybe found more friends or found something to do with my time, but I don't want to at the same time. So I'm frustrated with myself because I kind of know what would help, but then I don't really have the... like the volition to do it.","Therapist: ""Something's changed. So for a long time, you were satisfied being a housewife. You enjoyed that life or found satisfaction in that life. And somewhere along the line, something changed in you. And now you're not happy with it. Yeah. So what it represents in terms of activities, like caring for your children and shopping, none of that's really changed.""
Patient: ""Yeah. Exactly. Well, I guess, you know, my youngest is eight, so he's only been in school for a couple of years, so I guess, like, it's not super recent, but recently he, I finally have no children in the home, so it's more, it's more time to myself. and I kind of filled that gap a little bit with other things like I did Cub Scouts with the boys for a while and like I said I had some friends around the neighborhood so that kind of like filled that time but now that stuff it's just not really happening anymore so now I kind of feel like it's not it's not boredom you know it's not like I don't have enough to do it's like I don't want to do anything but then at the same time I feel frustrated because there's nothing to do""
Therapist: ""Alright, so you're frustrated with your situation, maybe with yourself a little bit.""",236.69,262.24
009_014,009,14,5,"Yeah, I mean, obviously my husband has noticed because he has to get the boys ready in the morning. He's really supportive. I know he can tell that I'm not feeling the same, but you know, he works and then he has to come home and pick up my slack. So he is getting frustrated, which I understand. And, you know, my mom has said to me that, you know, she thinks I'm not doing as much. And so it kind of hurts. It feels like everybody's trying to tell me I'm lazy and that I'm not doing enough. And it's always that, like, feeling, you know, like nobody really understands how much work goes into being a mother. But then at the same time, now that I'm doing less and less, I feel like they're all right. You know, I am lazy. I'm not doing anything.","Therapist: ""You're not motivated?""
Patient: ""Yeah, I'm not motivated.""
Therapist: ""Have you received any feedback from other people about this meeting? Has anyone else noticed that you're down?""",272.98,316.85
009_016,009,16,2,"No, not that I can remember. You know, I think my mom said, like, you're not doing as much as you used to. And I kind of took offense to that. Even though it's kind of true, it's like, I don't know. It hurt.","Therapist: ""Have you received any feedback from other people about this meeting? Has anyone else noticed that you're down?""
Patient: ""Yeah, I mean, obviously my husband has noticed because he has to get the boys ready in the morning. He's really supportive. I know he can tell that I'm not feeling the same, but you know, he works and then he has to come home and pick up my slack. So he is getting frustrated, which I understand. And, you know, my mom has said to me that, you know, she thinks I'm not doing as much. And so it kind of hurts. It feels like everybody's trying to tell me I'm lazy and that I'm not doing enough. And it's always that, like, feeling, you know, like nobody really understands how much work goes into being a mother. But then at the same time, now that I'm doing less and less, I feel like they're all right. You know, I am lazy. I'm not doing anything.""
Therapist: ""Do they use the word lazy?""",320.61,338.46
009_018,009,18,4,"You know, I think at first we didn't really acknowledge it, it was like, you know, I took a break here, he picked up the slack and it was fine, but now that it's been more and more, he's kind of getting frustrated and, you know, he's been asking me about how I feel and why I'm not doing as much, but at the same time, like, even though he knows that I'm not motivated, it's still frustrating because it's my responsibility so I think he's you know he's been saying like I need you to do more around the house pretty much is what he said I need you to do more.","Therapist: ""Do they use the word lazy?""
Patient: ""No, not that I can remember. You know, I think my mom said, like, you're not doing as much as you used to. And I kind of took offense to that. Even though it's kind of true, it's like, I don't know. It hurt.""
Therapist: ""Okay, that was painful for you. What about what your husband said? What's he been saying?""",349.38,390.29
009_020,009,20,4,"I started crying because I know he's right and that's what I tell myself every day I need to do more but I don't have the motivation to do it and so I'm so frustrated with myself and, you know, I know that he needs that from me and I don't know why I'm not motivated to do it.","Therapist: ""Okay, that was painful for you. What about what your husband said? What's he been saying?""
Patient: ""You know, I think at first we didn't really acknowledge it, it was like, you know, I took a break here, he picked up the slack and it was fine, but now that it's been more and more, he's kind of getting frustrated and, you know, he's been asking me about how I feel and why I'm not doing as much, but at the same time, like, even though he knows that I'm not motivated, it's still frustrating because it's my responsibility so I think he's you know he's been saying like I need you to do more around the house pretty much is what he said I need you to do more.""
Therapist: ""What was your response to that when he said I need you to do more?""",395.84,415.92
009_022,009,22,5,"Yeah. Yeah, I actually think, you know, I've been feeling this way more, like, in the past, like, six months or something like that. Like, I, it was hard for me when my, my youngest son went to school, but more in, like, the natural way that it is hard. Um, but this is something else. This is more consuming. It's You know, like the difficulty of him going away to school almost was motivating. Like it was hard, but at the same time it was freeing because I had other opportunities to do stuff. This is just like stunting.","Therapist: ""What was your response to that when he said I need you to do more?""
Patient: ""I started crying because I know he's right and that's what I tell myself every day I need to do more but I don't have the motivation to do it and so I'm so frustrated with myself and, you know, I know that he needs that from me and I don't know why I'm not motivated to do it.""
Therapist: ""Okay, so you're frustrated for feeling down. Yeah. And you're frustrated for lacking motivation. And just as little as a few years ago, you didn't feel it this way at all.""",438.11,479.98
009_024,009,24,4,"Sure. On Wednesday, I was having a really hard time getting out of bed, so my husband just got the kids ready in the morning, and I felt really bad about that, so I just stayed in bed for a couple more hours, probably until like 10.30. And I got up, you know, and made myself something to eat. and then I thought you know I should probably go to the store because we're almost out of milk and you know and I think the boys need shampoo but I just I just sat down and I just sat there and I think I sat for I don't even know how long the boys came home from school it was like you know 3.30 and I hadn't even gotten up and So then I said, okay, the boys are home. I should probably get started on dinner soon because my husband will be home soon. And I found something in the fridge to make, and I made dinner. And, you know, after that, everybody, you know, just sat down. We just watched TV, and I just sat there until it was time to go to bed.","Therapist: ""Okay, so you're frustrated for feeling down. Yeah. And you're frustrated for lacking motivation. And just as little as a few years ago, you didn't feel it this way at all.""
Patient: ""Yeah. Yeah, I actually think, you know, I've been feeling this way more, like, in the past, like, six months or something like that. Like, I, it was hard for me when my, my youngest son went to school, but more in, like, the natural way that it is hard. Um, but this is something else. This is more consuming. It's You know, like the difficulty of him going away to school almost was motivating. Like it was hard, but at the same time it was freeing because I had other opportunities to do stuff. This is just like stunting.""
Therapist: ""Okay. So let me shift gears a little bit. Can you tell me about your, well, a recent day? It's kind of typical what you're telling me now, meaning... not motivated, down?""",496.59,569.91
009_027,009,27,1,"I wish that I would wake up and, you know, I would want to wake up when it was time for the kids to get ready to school, to go to school. You know, I could make sure that everything, that they had everything they needed. I could pack their lunches and get the boys dressed and you know, check they needed any permission slip sign, that kind of thing. Send them out the door and then I would see if we needed anything from the store. I'd probably do a little bit of cleaning around the house. I used to, like, have, like, a list of chores that, like, I would do different things on different days and different days of the month and stuff. So, like, bedding would get washed one day of the week and that kind of thing so I would probably like follow that list. Nowadays I just you know if it gets done it gets done and usually my husband helps me with some of the stuff and you know I would do the bathrooms one day a week that probably gets done like once a month now but I would do that so do the cleaning if I needed to go to the store I would do that. I'd get ready for the boys to come home I'd probably make them a snack and and figure out what was going to be for dinner, I would go ahead and do that. And then probably, you know, sometimes we would watch TV after my husband got home after dinner, or I would figure out something for us to do. We could play a board game or all watch a movie as a family or something like that. But that would be after the kids did their homework and everything like that. And then after we spent some time together, I'd put them to bed.","Patient: ""Sure. On Wednesday, I was having a really hard time getting out of bed, so my husband just got the kids ready in the morning, and I felt really bad about that, so I just stayed in bed for a couple more hours, probably until like 10.30. And I got up, you know, and made myself something to eat. and then I thought you know I should probably go to the store because we're almost out of milk and you know and I think the boys need shampoo but I just I just sat down and I just sat there and I think I sat for I don't even know how long the boys came home from school it was like you know 3.30 and I hadn't even gotten up and So then I said, okay, the boys are home. I should probably get started on dinner soon because my husband will be home soon. And I found something in the fridge to make, and I made dinner. And, you know, after that, everybody, you know, just sat down. We just watched TV, and I just sat there until it was time to go to bed.""
Therapist: ""All right. And you said this was recently, right?""
Therapist: ""What would the ideal day have looked like? Take that same day and do what you wish you could have done.""",584.57,683.85
009_029,009,29,4,"It's just like, you know, the alarm goes off and I know it's time to get up and my husband's getting out of bed and I just look at the clock and I think, what's the point? And, you know, it's just this instant feeling of... I can't even describe it. Like, pointlessness of getting up. And... So I go back to sleep, but I feel worse for doing it. You know, like it's a catch 22. Like I don't want to wake up. I just don't want to. But then when I go back to sleep, I feel bad. I feel guilty.","Therapist: ""What would the ideal day have looked like? Take that same day and do what you wish you could have done.""
Patient: ""I wish that I would wake up and, you know, I would want to wake up when it was time for the kids to get ready to school, to go to school. You know, I could make sure that everything, that they had everything they needed. I could pack their lunches and get the boys dressed and you know, check they needed any permission slip sign, that kind of thing. Send them out the door and then I would see if we needed anything from the store. I'd probably do a little bit of cleaning around the house. I used to, like, have, like, a list of chores that, like, I would do different things on different days and different days of the month and stuff. So, like, bedding would get washed one day of the week and that kind of thing so I would probably like follow that list. Nowadays I just you know if it gets done it gets done and usually my husband helps me with some of the stuff and you know I would do the bathrooms one day a week that probably gets done like once a month now but I would do that so do the cleaning if I needed to go to the store I would do that. I'd get ready for the boys to come home I'd probably make them a snack and and figure out what was going to be for dinner, I would go ahead and do that. And then probably, you know, sometimes we would watch TV after my husband got home after dinner, or I would figure out something for us to do. We could play a board game or all watch a movie as a family or something like that. But that would be after the kids did their homework and everything like that. And then after we spent some time together, I'd put them to bed.""
Therapist: ""All right. So there's a fairly wide discrepancy between where you are. in terms of behavior and where you want to be. So, let me ask you a very specific question about one of the first things in the day. You had mentioned that when it was time to get up, you didn't. So, you were awake and aware of it, but you went back to sleep, I presume. And, of course, your husband got up and he took care of things. How did you feel allowing that to happen? Because clearly that's not what you wanted to happen. How did you feel about that over sleeping?""",727.63,766.64
009_031,009,31,5,"It just... It's just like, you know, when I'm sleeping, I don't realize how sad I am. And I don't realize how hard it is to function. When I'm sleeping, I'm not aware of that. And as soon as I wake up, I am. And so, I just have this feeling of like, what's the point of getting up and experiencing these feelings when I could go back to sleep and not have to.","Therapist: ""All right. So there's a fairly wide discrepancy between where you are. in terms of behavior and where you want to be. So, let me ask you a very specific question about one of the first things in the day. You had mentioned that when it was time to get up, you didn't. So, you were awake and aware of it, but you went back to sleep, I presume. And, of course, your husband got up and he took care of things. How did you feel allowing that to happen? Because clearly that's not what you wanted to happen. How did you feel about that over sleeping?""
Patient: ""It's just like, you know, the alarm goes off and I know it's time to get up and my husband's getting out of bed and I just look at the clock and I think, what's the point? And, you know, it's just this instant feeling of... I can't even describe it. Like, pointlessness of getting up. And... So I go back to sleep, but I feel worse for doing it. You know, like it's a catch 22. Like I don't want to wake up. I just don't want to. But then when I go back to sleep, I feel bad. I feel guilty.""
Therapist: ""Okay. So I'm not getting up in the time you wanted. You feel guilty. But you also mentioned something that you thought. which was, if I'm not mistaken, you said, what's the point? Can you expand on that?""",785.48,816.14
009_033,009,33,4,"Yes, yeah.","Therapist: ""Okay. So I'm not getting up in the time you wanted. You feel guilty. But you also mentioned something that you thought. which was, if I'm not mistaken, you said, what's the point? Can you expand on that?""
Patient: ""It just... It's just like, you know, when I'm sleeping, I don't realize how sad I am. And I don't realize how hard it is to function. When I'm sleeping, I'm not aware of that. And as soon as I wake up, I am. And so, I just have this feeling of like, what's the point of getting up and experiencing these feelings when I could go back to sleep and not have to.""
Therapist: ""What's the point of getting up when sleeping will keep the pain at bay?""",819.34,822.23
009_035,009,35,2,"Yeah, yeah, definitely, definitely.","Therapist: ""What's the point of getting up when sleeping will keep the pain at bay?""
Patient: ""Yes, yeah.""
Therapist: ""Okay. But then, when you do get up, you feel sad and guilty about having overslept.""",833.51,835.89
009_037,009,37,5,Yeah.,"Therapist: ""Okay. But then, when you do get up, you feel sad and guilty about having overslept.""
Patient: ""Yeah, yeah, definitely, definitely.""
Therapist: ""So really, functionally what you're doing is you're delaying experiencing the pain. Yeah. And then in terms of how it affects your relationships and your family, you're not getting your kids off to school, your husband's getting a little frustrated, And all you've really bought yourself is a couple extra hours sleep. And, you know, presumably without pain because you're sleeping. But you're not really escaping it. Does that make sense?""",872.35,876.15
009_039,009,39,1,"Yeah, it was so easy. I would just, like... you know I would wake up and and I would be like okay it's time to get up and get out of bed and get ready to go I mean you know sometimes if if if I was a little bit tired it would be a little bit hard but you know it's not you know as a stay-at-home mom I usually get enough sleep for the most part now that the kids are older and everything so it's not usually too hard to get up and I would I would you know it would be another good day, you know? I would be glad to get up and take care of the things that I needed to take care of and I felt accomplished.","Therapist: ""So really, functionally what you're doing is you're delaying experiencing the pain. Yeah. And then in terms of how it affects your relationships and your family, you're not getting your kids off to school, your husband's getting a little frustrated, And all you've really bought yourself is a couple extra hours sleep. And, you know, presumably without pain because you're sleeping. But you're not really escaping it. Does that make sense?""
Patient: ""Yeah.""
Therapist: ""Before, when you felt more satisfaction and purpose, did you get up and help the kids off to school?""",883.4,920.48
009_041,009,41,2,"I mean, I want everything to be normal again. And I guess I never really thought of it like that. Like, I just thought, well, if I'm waking up at the right time and I'm just feeling bad, then, like I said, what's the point? But I guess it makes sense, like, even if I don't feel like doing it, maybe it'll make me feel better if I do do it, even if it's hard. Because nothing's really harder than what I'm already going through.","Therapist: ""Before, when you felt more satisfaction and purpose, did you get up and help the kids off to school?""
Patient: ""Yeah, it was so easy. I would just, like... you know I would wake up and and I would be like okay it's time to get up and get out of bed and get ready to go I mean you know sometimes if if if I was a little bit tired it would be a little bit hard but you know it's not you know as a stay-at-home mom I usually get enough sleep for the most part now that the kids are older and everything so it's not usually too hard to get up and I would I would you know it would be another good day, you know? I would be glad to get up and take care of the things that I needed to take care of and I felt accomplished.""
Therapist: ""Alright, so maybe what's going on here, or maybe it could help. You remember, you know, over the last few sessions we've talked about cognitive behavioral therapy and the different techniques that I'll be using and different things we'll be talking about. Sometimes with behavior, the behavior that's useful, which in this case I'm assuming we can agree is the getting up one time. Behavior that's useful has to come first, even if the feeling doesn't match. Right? So, sleeping those extra, I presume, you know, a couple hours delays you from feeling sad and it causes other problems. If you were to get up one time, you might still feel sad, right? Because That's why you're oversleeping, because you're sleeping longer to avoid that. But the functional part of being a housewife, as you identified, would be completed. So maybe some of those feelings of sadness and guilt would, over time, abate. Because, functionally speaking, you're completing the task that you want. What's tough about that is that in the moment, it's easy for me to say this now, right? But in the moment, like for instance when you have to get out of bed tomorrow, you're going to be facing that same challenge, which is I can get up now and feel depressed, or I can wait and feel depressed later. So in that moment, it's hard to act on the behavior that you kind of know you want to move towards. I mean, it sounds like you want to Yeah, yeah.""",1024.92,1052.89
009_043,009,43,2,"Yeah, and also I guess I thought that no, it wouldn't really be that beneficial to get up.","Therapist: ""Alright, so maybe what's going on here, or maybe it could help. You remember, you know, over the last few sessions we've talked about cognitive behavioral therapy and the different techniques that I'll be using and different things we'll be talking about. Sometimes with behavior, the behavior that's useful, which in this case I'm assuming we can agree is the getting up one time. Behavior that's useful has to come first, even if the feeling doesn't match. Right? So, sleeping those extra, I presume, you know, a couple hours delays you from feeling sad and it causes other problems. If you were to get up one time, you might still feel sad, right? Because That's why you're oversleeping, because you're sleeping longer to avoid that. But the functional part of being a housewife, as you identified, would be completed. So maybe some of those feelings of sadness and guilt would, over time, abate. Because, functionally speaking, you're completing the task that you want. What's tough about that is that in the moment, it's easy for me to say this now, right? But in the moment, like for instance when you have to get out of bed tomorrow, you're going to be facing that same challenge, which is I can get up now and feel depressed, or I can wait and feel depressed later. So in that moment, it's hard to act on the behavior that you kind of know you want to move towards. I mean, it sounds like you want to Yeah, yeah.""
Patient: ""I mean, I want everything to be normal again. And I guess I never really thought of it like that. Like, I just thought, well, if I'm waking up at the right time and I'm just feeling bad, then, like I said, what's the point? But I guess it makes sense, like, even if I don't feel like doing it, maybe it'll make me feel better if I do do it, even if it's hard. Because nothing's really harder than what I'm already going through.""
Therapist: ""Well, it seems like you're more or less making things worse, right, in an effort to avoid the pain that you're going to suffer anyway. You're making the pain worse and just delaying it a little bit, right? What thought, remember we talked before about automatic thoughts, these thoughts that come up kind of when your belief system meets these different situations that occur. When you have that thought that this is pointless, right, and I'm going to expand on that thought a little and say that what that thought's really getting at is, I can avoid this pain if I sleep a little while longer. That's a version of the thought. Does that make sense?""",1094.47,1102.5
009_046,009,46,3,"I mean, I guess I could tell myself, like, I can do this. Like, instead of, you know, when I say to myself, what's the point? Instead I can say, I can do this. I can get out of it. It'll be okay. I can, I'm strong enough, even though it's hard, to push through the pain and get up now, even though I don't want to. I can say, I can do this.","Patient: ""Yeah, and also I guess I thought that no, it wouldn't really be that beneficial to get up.""
Therapist: ""Okay. So you're also minimizing the benefit.""
Therapist: ""So there's a couple things going on, right? I can avoid the pain by sleeping in, and there's really no point to... to getting up because I won't do any good anyway. What adaptive response, that self-talk we talked about, those things we consciously think to ourselves, could you apply in that moment when you're, you know, whatever time you get up in the morning when you're thinking about this and that thought comes in that, you know, it doesn't really matter if I get up anyway.""",1136.1,1157.89
009_049,009,49,2,"Yeah, I mean I know it's valuable. I guess what my frustration is is that I know it's valuable and it used to give me like an emotional payoff of like pride and satisfaction and now I'm not getting that anymore. So I guess I need to realize that even though I'm not getting it right now, if I keep trying, maybe it will happen again because it did happen before.","Patient: ""I mean, I guess I could tell myself, like, I can do this. Like, instead of, you know, when I say to myself, what's the point? Instead I can say, I can do this. I can get out of it. It'll be okay. I can, I'm strong enough, even though it's hard, to push through the pain and get up now, even though I don't want to. I can say, I can do this.""
Therapist: ""Okay. So that would be your adaptive response. I'm strong enough. I can get through this, but it will be difficult.""
Therapist: ""How about the value of getting up early and seeing the kids off to school? The automatic thought right now is telling you that's not valuable. But I think that you believe it is valuable.""",1177.01,1205.63
009_051,009,51,4,I guess that's true. I'll never get the satisfaction of sending my kids off to school if I never send my kids off to school.,"Therapist: ""How about the value of getting up early and seeing the kids off to school? The automatic thought right now is telling you that's not valuable. But I think that you believe it is valuable.""
Patient: ""Yeah, I mean I know it's valuable. I guess what my frustration is is that I know it's valuable and it used to give me like an emotional payoff of like pride and satisfaction and now I'm not getting that anymore. So I guess I need to realize that even though I'm not getting it right now, if I keep trying, maybe it will happen again because it did happen before.""
Therapist: ""Well, it would seem logical that you have a higher probability of getting that back if you do get up than if you...""",1212.41,1219.54
009_057,009,57,3,"Yeah, and not letting the negative thoughts take over, because that's what I'm thinking, like, okay, I can get the kids off to school, but after that, I'm gonna start thinking, you know, what's the point again? Like, why don't I just sit down? There's no point. So if I can keep reminding myself that I just have to try, and that I did accomplish something, and then, you know, even though it's hard, and I know that those thoughts are gonna come back, and that I'm gonna feel bad, If I don't do anything, I'm not going to feel any better.","Therapist: ""Does that kind of make sense?""
Patient: ""Yeah.""
Therapist: ""So even though getting up early is going to be painful and going to seem like not a practical move, logically you know that it has a better chance of paying off for you. And I think that with these type of, what you're going through is probably depression. I'd like to talk to you further to make sure that's what's going on, but it seems like you're depressed. And sometimes with depression you just have to get one thing going your way each day. So I'm not saying necessarily tomorrow you have to get up one time and then go make new friends and then go find social activities. You don't have to build Rome in a day here. It's more like can I this one thing. Can I prove to myself just what I'm saying, which is I'm strong enough to get up, see the kids off and have that one victory for tomorrow. And build on that. And part of that's going to be playing those adaptive responses back. Thinking those thoughts. Whether it's just thinking them in your mind or actually thinking them and saying them. Sometimes it's helpful just to say them out loud.""",1312.3,1345.1
010_002,010,2,1,"I'm doing well, thank you. How about yourself?","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""
Therapist: ""Hello Aspen, how are you doing today?""",25.23,27.51
010_004,010,4,1,"Nothing's really changed. I mean, I'm amazing at my job. My boss just really is someone that I hold You know, in higher regards than others I work with, especially. We went to the same college. It was an Ivy League college, of course. And he suggested I come into counseling, and he's way off, way off. So I'm just going to, you know, let him know.","Therapist: ""Hello Aspen, how are you doing today?""
Patient: ""I'm doing well, thank you. How about yourself?""
Therapist: ""I'm doing alright, thanks for asking. I had met you last time for our first session and we talked a little bit about kind of your circumstances, what brought you here. And I was hoping today we could get into trying to really figure out how we can help you. Any thoughts on your current situation? Anything change?""",50.32,81.08
010_006,010,6,3,"That was what initiated it, but now I need to prove him wrong.","Therapist: ""I'm doing alright, thanks for asking. I had met you last time for our first session and we talked a little bit about kind of your circumstances, what brought you here. And I was hoping today we could get into trying to really figure out how we can help you. Any thoughts on your current situation? Anything change?""
Patient: ""Nothing's really changed. I mean, I'm amazing at my job. My boss just really is someone that I hold You know, in higher regards than others I work with, especially. We went to the same college. It was an Ivy League college, of course. And he suggested I come into counseling, and he's way off, way off. So I'm just going to, you know, let him know.""
Therapist: ""So, as I understand it, you came into counseling because he requested it.""",91.89,95.89
010_008,010,8,1,"Yeah, have a little bit of fun with it, prove my point.","Therapist: ""So, as I understand it, you came into counseling because he requested it.""
Patient: ""That was what initiated it, but now I need to prove him wrong.""
Therapist: ""Alright, so at first it was because he told you it would be a good idea, but now you kind of see it as an opportunity to prove your point.""",104.74,108.4
010_010,010,10,3,"That I'm not the one in the wrong, you know? I'm extremely good at my job. I mean, I am the best employee that they have ever had, not just currently. I mean, just ever. I make no errors. So how can I be wrong when it comes to these circumstances with my coworkers?","Therapist: ""Alright, so at first it was because he told you it would be a good idea, but now you kind of see it as an opportunity to prove your point.""
Patient: ""Yeah, have a little bit of fun with it, prove my point.""
Therapist: ""What would you like to prove through this?""",112.81,130.24
010_012,010,12,4,"I would call them criticisms because it's really hard to criticize me. So I would say they take it personally that I'm better than them. You know, so I feel that it's important for me to be able to work for this particular company. It needs to be the best company. And so I need the other employees to at least be at my level. Well, I mean, that's... That's really hard for them to come to my level, but at least be above average, at least.","Therapist: ""What would you like to prove through this?""
Patient: ""That I'm not the one in the wrong, you know? I'm extremely good at my job. I mean, I am the best employee that they have ever had, not just currently. I mean, just ever. I make no errors. So how can I be wrong when it comes to these circumstances with my coworkers?""
Therapist: ""Right. So your coworkers have made some criticisms about you, and that led to your boss suggesting this.""",140.79,174.18
010_014,010,14,2,"I mean, it's pretty hard to not make any errors when it comes to accounting. With the numbers, with the amount of numbers and the volume of accounts that we have, it's hard to be as good as I am with it as far as no errors. Yes, I expect a higher standard from the coworkers.","Therapist: ""Right. So your coworkers have made some criticisms about you, and that led to your boss suggesting this.""
Patient: ""I would call them criticisms because it's really hard to criticize me. So I would say they take it personally that I'm better than them. You know, so I feel that it's important for me to be able to work for this particular company. It needs to be the best company. And so I need the other employees to at least be at my level. Well, I mean, that's... That's really hard for them to come to my level, but at least be above average, at least.""
Therapist: ""All right, so you have an expectation of them to become at least close to you in terms of your skill?""",184.09,204.26
010_016,010,16,1,I just pointed out the facts of the situation.,"Therapist: ""All right, so you have an expectation of them to become at least close to you in terms of your skill?""
Patient: ""I mean, it's pretty hard to not make any errors when it comes to accounting. With the numbers, with the amount of numbers and the volume of accounts that we have, it's hard to be as good as I am with it as far as no errors. Yes, I expect a higher standard from the coworkers.""
Therapist: ""And you don't feel like they're performing at that level now? No, not at all. And evidently you made some different comments to them, which maybe they took the wrong way.""",218.11,220.57
010_018,010,18,2,when they make mistakes and you know how how they should be better at certain tasks i mean i mean they didn't attend the same you know type of college as far as you know you know ivy league as myself um however they do have a college education so you know that alone would you know just kind of go to speak to them having some sort of ability in that area,"Therapist: ""And you don't feel like they're performing at that level now? No, not at all. And evidently you made some different comments to them, which maybe they took the wrong way.""
Patient: ""I just pointed out the facts of the situation.""
Therapist: ""What type of facts did you?""",224.46,250.56
010_022,010,22,4,"Oh, they told me my ego's too big, that I'm cocky, that's one. Yeah, that I'm just overall, like, I don't know how you can be too confident when your ability is at that level. I mean, I am the best employee they've ever had. I was the best student at my college. I received numerous awards from the president of the college alone. I received numerous calls. from the college and other companies as well, trying to recruit me to work for them. You know, so I don't think there's, it's impossible to be overly confident, but they, you know, they consider it cocky and arrogant, get arrogant a lot.","Therapist: ""So you've kind of, in a way, you've expressed your disappointment with them. Yes. To them.""
Patient: ""Yes. Yeah.""
Therapist: ""And what are some of the observations or comments they made regarding you?""",268.15,327.24
010_025,010,25,1,I think they take it as a personal attack. Like I'm that concerned with them personally. Like I'm talking about them as a person instead of just their performance at work. Because I'm really not concerned with them as far as existence outside the realm of performance at work.,"Patient: ""Oh, they told me my ego's too big, that I'm cocky, that's one. Yeah, that I'm just overall, like, I don't know how you can be too confident when your ability is at that level. I mean, I am the best employee they've ever had. I was the best student at my college. I received numerous awards from the president of the college alone. I received numerous calls. from the college and other companies as well, trying to recruit me to work for them. You know, so I don't think there's, it's impossible to be overly confident, but they, you know, they consider it cocky and arrogant, get arrogant a lot.""
Therapist: ""The comment arrogant?""
Therapist: ""So you feel they're just really, are they misunderstanding you?""",337.16,360.89
010_028,010,28,4,"Taking it personally and trying as best they can to push it back on me as I'm the one who's wrong, but I'm obviously not.","Patient: ""I think they take it as a personal attack. Like I'm that concerned with them personally. Like I'm talking about them as a person instead of just their performance at work. Because I'm really not concerned with them as far as existence outside the realm of performance at work.""
Therapist: ""So your commentary to them has nothing to do with their value as a person, more with their performance as an employee.""
Therapist: ""and you feel they're misconstruing your observations about their performance. Very much so. Yeah, they're taking it personally.""",375.96,383.21
010_030,010,30,1,"I mean, I'm okay with it, you know? I mean, I don't really take anything they say to heart. because they're not at the level to really be able to criticize me. You know, I can take criticism, you know, from constructive criticism from someone who would, you know, be at my level or above, however they are not. So it's really not, it really doesn't affect me. It does interfere with my job as far as my employer is concerned.","Therapist: ""and you feel they're misconstruing your observations about their performance. Very much so. Yeah, they're taking it personally.""
Patient: ""Taking it personally and trying as best they can to push it back on me as I'm the one who's wrong, but I'm obviously not.""
Therapist: ""All right, so you're not wrong in this, and you're frustrated by their reactions.""",392.0,424.59
010_032,010,32,1,"I mean, overall, I like this company. I like working for it. been friends with my boss. I mean, we went to the same college, you know, so we have that in common. You know, he is an extraordinary person as far as his abilities. You know, I would say as in the level realm as myself. So, you know, I hold his, you know, opinion, you know, in some sort of regards above the others.","Therapist: ""All right, so you're not wrong in this, and you're frustrated by their reactions.""
Patient: ""I mean, I'm okay with it, you know? I mean, I don't really take anything they say to heart. because they're not at the level to really be able to criticize me. You know, I can take criticism, you know, from constructive criticism from someone who would, you know, be at my level or above, however they are not. So it's really not, it really doesn't affect me. It does interfere with my job as far as my employer is concerned.""
Therapist: ""Right. That's what led to you. That's what led to him recommending you come here initially. Yes. Right. So you don't feel that they're at a level where they can really criticize you. It doesn't really bother you if they have criticism in the first place. But you can appreciate how getting along with them would be better for you as an employee.""",448.84,482.51
010_034,010,34,2,"Well, I think it's on their area, you know, on their side. They didn't take what I said the wrong way.","Therapist: ""Right. That's what led to you. That's what led to him recommending you come here initially. Yes. Right. So you don't feel that they're at a level where they can really criticize you. It doesn't really bother you if they have criticism in the first place. But you can appreciate how getting along with them would be better for you as an employee.""
Patient: ""I mean, overall, I like this company. I like working for it. been friends with my boss. I mean, we went to the same college, you know, so we have that in common. You know, he is an extraordinary person as far as his abilities. You know, I would say as in the level realm as myself. So, you know, I hold his, you know, opinion, you know, in some sort of regards above the others.""
Therapist: ""Okay, so to the extent that they... communicate negative sentiment to him about you, that affects you? Yes. Okay. Yes. And so what do you think, if anything, what do you think needs to be fixed here?""",507.52,517.47
010_036,010,36,2,"If they worked at it, possibly.","Therapist: ""Okay, so to the extent that they... communicate negative sentiment to him about you, that affects you? Yes. Okay. Yes. And so what do you think, if anything, what do you think needs to be fixed here?""
Patient: ""Well, I think it's on their area, you know, on their side. They didn't take what I said the wrong way.""
Therapist: ""Okay. So if they had accurately interpreted your comments, that would fix the problem? Yes. Do you think that's realistic?""",532.45,534.45
010_041,010,41,3,"Well, every now and then, this is, we've hit a peak here recently because a lot of the people that I work with feel, here recently more so they've been taken in the wrong way, more prevalent than in the past. In the past they would, you know, I'd hear, you know, certain comments, but I understood, you know, comments just directed at me and I just understood that, you know, it was just, Envious because I was able to give them I was at a level where I was able to critique their work So wasn't it never got to a point where I had someone like my boss say anything to me So this is really the first time That it's gotten to that point So you've noticed things like this in the past but now it's Become more urgent to address it It's become more urgent to prove that I'm not wrong in this fact, that it is, you know, if this were the case, then, you know, it would have been, you know, it would have been continuous, not just, oh, some come to a head. So, I mean, that just proves my point even more, that it is their issue and not mine.","Patient: ""That's been about 15 years.""
Therapist: ""Fifteen years?""
Therapist: ""And how long has this been something that you've been aware of, them not feeling so great about your comments to them?""",553.03,628.78
010_043,010,43,3,"I mean, it's kind of... To me, it's obvious they are in the wrong because the numbers speak for themselves. It's the fact of the matter. So if... But I guess that if there was something that could change between the relationships that I have with them, then at least would be a little bit better of a flow. So maybe we could get up to the level, you know, that this company is deserving of.","Therapist: ""And how long has this been something that you've been aware of, them not feeling so great about your comments to them?""
Patient: ""Well, every now and then, this is, we've hit a peak here recently because a lot of the people that I work with feel, here recently more so they've been taken in the wrong way, more prevalent than in the past. In the past they would, you know, I'd hear, you know, certain comments, but I understood, you know, comments just directed at me and I just understood that, you know, it was just, Envious because I was able to give them I was at a level where I was able to critique their work So wasn't it never got to a point where I had someone like my boss say anything to me So this is really the first time That it's gotten to that point So you've noticed things like this in the past but now it's Become more urgent to address it It's become more urgent to prove that I'm not wrong in this fact, that it is, you know, if this were the case, then, you know, it would have been, you know, it would have been continuous, not just, oh, some come to a head. So, I mean, that just proves my point even more, that it is their issue and not mine.""
Therapist: ""All right, so if you could somehow prove that they're in the wrong, Would that help you?""",643.99,684.9
010_045,010,45,3,"I need to figure out a way to present the information at a level that they would understand, so drop it down to their level, but also kind of sugarcoat it so they're not, you know, taking it the wrong way.","Therapist: ""All right, so if you could somehow prove that they're in the wrong, Would that help you?""
Patient: ""I mean, it's kind of... To me, it's obvious they are in the wrong because the numbers speak for themselves. It's the fact of the matter. So if... But I guess that if there was something that could change between the relationships that I have with them, then at least would be a little bit better of a flow. So maybe we could get up to the level, you know, that this company is deserving of.""
Therapist: ""Okay, so there's like two things operating. There's your desire for them to improve and make the company better, and then their desire discontent with your comments to them. So you'd like the company to improve, and you feel that means that you need to be able to voice your opinion to them in an honest way. But everybody needs to get along too, and that's, at least to some extent, and that's not happening because they're upset. So do you think there's any steps you could take that could reduce the tension in those relationships?""",738.15,763.76
010_047,010,47,4,"I mean, you could say that, yeah.","Therapist: ""Okay, so there's like two things operating. There's your desire for them to improve and make the company better, and then their desire discontent with your comments to them. So you'd like the company to improve, and you feel that means that you need to be able to voice your opinion to them in an honest way. But everybody needs to get along too, and that's, at least to some extent, and that's not happening because they're upset. So do you think there's any steps you could take that could reduce the tension in those relationships?""
Patient: ""I need to figure out a way to present the information at a level that they would understand, so drop it down to their level, but also kind of sugarcoat it so they're not, you know, taking it the wrong way.""
Therapist: ""Alright, so you need to deliver the same message in a more polite, less threatening package.""",775.06,777.14
010_049,010,49,1,"I mean, I could start with not comparing their work to mine, because that's just unfair. I mean, at no point in time are they ever going to reach that level of quality with their work, so that could be a place to start.","Therapist: ""Alright, so you need to deliver the same message in a more polite, less threatening package.""
Patient: ""I mean, you could say that, yeah.""
Therapist: ""Do you have any ideas how that might look?""",791.3,804.08
010_051,010,51,2,Yeah.,"Therapist: ""Do you have any ideas how that might look?""
Patient: ""I mean, I could start with not comparing their work to mine, because that's just unfair. I mean, at no point in time are they ever going to reach that level of quality with their work, so that could be a place to start.""
Therapist: ""Okay, so just refraining from drawing that comparison, that could help.""",810.79,812.99
010_053,010,53,1,"I could see where you would say, you know, refer to that as cool down.","Therapist: ""Okay, so just refraining from drawing that comparison, that could help.""
Patient: ""Yeah.""
Therapist: ""Do you think there could be a benefit in just taking a break from offering any comments to them? Any observations? Just to let things cool down a bit?""",825.69,830.39
010_055,010,55,1,"Yeah, just keep to myself a little bit more. I mean, that's not very hard around them.","Therapist: ""Do you think there could be a benefit in just taking a break from offering any comments to them? Any observations? Just to let things cool down a bit?""
Patient: ""I could see where you would say, you know, refer to that as cool down.""
Therapist: ""Just in an effort to restore the peace. You could still, of course, be aware of different shortcomings in their performance. It might just be helpful to not share that for a while. Just as an idea. Does that seem like an idea that might work?""",855.82,862.58
010_058,010,58,3,"I mean, if, well, really, it would, in fact, prove my point behind it all. It would prove that I was right, that it's not me, that it is them taking it the wrong way, you know. Because, in fact, if it was, you know, if it wasn't them taking it the wrong way, then I would say that,","Patient: ""Yeah, just keep to myself a little bit more. I mean, that's not very hard around them.""
Therapist: ""Keep it to yourself?""
Therapist: ""Do you think you would be okay with doing that? Because you wouldn't really be able to offer those helpful comments, like about performance.""",882.89,909.0
010_059,010,59,1,"I would, you know, it would continue as far as trying to point out, I mean, really I think it comes down to an issue of being jealous and seeing themselves as less than. So needing to bring, to try to bring me down to make themselves feel better. So if they don't have that to do that, it would prove my point behind this whole thing.","Therapist: ""Keep it to yourself?""
Therapist: ""Do you think you would be okay with doing that? Because you wouldn't really be able to offer those helpful comments, like about performance.""
Patient: ""I mean, if, well, really, it would, in fact, prove my point behind it all. It would prove that I was right, that it's not me, that it is them taking it the wrong way, you know. Because, in fact, if it was, you know, if it wasn't them taking it the wrong way, then I would say that,""",914.45,940.3
010_061,010,61,1,"Oh, definitely. Yeah.","Patient: ""I mean, if, well, really, it would, in fact, prove my point behind it all. It would prove that I was right, that it's not me, that it is them taking it the wrong way, you know. Because, in fact, if it was, you know, if it wasn't them taking it the wrong way, then I would say that,""
Patient: ""I would, you know, it would continue as far as trying to point out, I mean, really I think it comes down to an issue of being jealous and seeing themselves as less than. So needing to bring, to try to bring me down to make themselves feel better. So if they don't have that to do that, it would prove my point behind this whole thing.""
Therapist: ""Yes, you feel like they're just trying to tear you down. to make up for their own inadequacy.""",948.15,950.3
010_063,010,63,2,Right. And then it's only a matter of time before someone else notices without me pointing that out to them.,"Therapist: ""Yes, you feel like they're just trying to tear you down. to make up for their own inadequacy.""
Patient: ""Oh, definitely. Yeah.""
Therapist: ""And by you just not kind of offering those observations, you're taking the wind out of their sails.""",961.33,967.58
010_070,010,70,2,"Yeah, I can tell you how I was proved to be right.","Therapist: ""Mm-hmm. Do you think this is a strategy that we can try out right away?""
Patient: ""Oh, yeah. I can handle it for sure.""
Therapist: ""Yeah. So I will see you again in about a week, if that's okay, and maybe we can reevaluate and see how that worked.""",1028.88,1030.98
011_004,011,4,4,"Yeah, I was trying to get hold of you. I had something I really needed to discuss with you but nobody called me back. I emailed you a couple times and never got a reply so I was just wondering what's going on with that.","Therapist: ""Hello Marci, how are you doing?""
Patient: ""I've been better.""
Therapist: ""Been better? Yeah. I saw that you called a few times between the last session and today you left a few messages.""",38.8,50.73
011_008,011,8,4,"Oh, yeah. He's useless. Anyway, go on. Did you attempt to... No, he's so busy with it. He could never help me. I don't think he even cares what I'm going through. He's got his own stuff to deal with. He's got his own family and all this stuff. Yeah, he doesn't care.","Therapist: ""We can talk about that. I wanted to talk about that after getting those messages. Remember we discussed the process for when your mood deteriorates and you had a few other resources you wanted to connect with Before calling me.""
Patient: ""Yeah, I kind of remember it.""
Therapist: ""Your brother was one of those resources.""",72.19,89.89
011_010,011,10,4,"Well, I did call my one friend, Beth, but she was like, oh, can I call you back? And, of course, she didn't because nobody ever calls me back. You know, they all have their own lives. No one really cares what I'm doing. You know, it's always like that. So that's why I thought I could reach out to you since you're supposed to be helping me, but apparently you never call me back or answer any of my emails, so.","Therapist: ""Your brother was one of those resources.""
Patient: ""Oh, yeah. He's useless. Anyway, go on. Did you attempt to... No, he's so busy with it. He could never help me. I don't think he even cares what I'm going through. He's got his own stuff to deal with. He's got his own family and all this stuff. Yeah, he doesn't care.""
Therapist: ""So you didn't contact him first because you thought he doesn't care? Yeah. Yeah. And we'd also talked about a few different friends that you had that you'd reach out to. You didn't contact them?""",102.78,124.91
011_012,011,12,4,"Yeah, I just feel like you're the only one that can help me. You know, I mean, my boyfriend, like, things aren't going well with him. I thought he could help me, but I guess he can't, and I think he's running around on me and all that. So I was just like, well, let me reach out to Dr. Grande and see if he can help me because it seems like my last resort. But","Therapist: ""So you didn't contact him first because you thought he doesn't care? Yeah. Yeah. And we'd also talked about a few different friends that you had that you'd reach out to. You didn't contact them?""
Patient: ""Well, I did call my one friend, Beth, but she was like, oh, can I call you back? And, of course, she didn't because nobody ever calls me back. You know, they all have their own lives. No one really cares what I'm doing. You know, it's always like that. So that's why I thought I could reach out to you since you're supposed to be helping me, but apparently you never call me back or answer any of my emails, so.""
Therapist: ""Right, we talked about how there's limitations on time and how it would be better if we could keep the therapy in here in person, right, and not get really too excessive with the telephone calls. I realize that when you're in distress, there's that kind of feeling that it would be a good idea to call, but remember we discussed different levels of distress, and if it's something common that you've been through before and you kind of know the outcome, connecting with one of those resources might be more helpful.""",161.53,184.38
011_014,011,14,4,"He was great. And then, you know, he was in the other room and he got a text message and I was like, well, let me just look at that. Because I was just curious to see what's going on with him because he never talks to me about anything. And so I looked at it and it was a girl's name and number that I didn't know. And... So he came back in and they put it away quickly. And I didn't say anything like, what's wrong with you? Because I was acting weird. And I was like, nothing. So then he went out. So I followed him. And then he went to some friend's house. And I don't know if there's girls there or not. So I kind of think he's running around with me. But I don't know. And I can't trust him. I can't trust anybody. So I don't know. I mean, he was so awesome before. But now I just don't know. But he was everything I ever wanted.","Therapist: ""Right, we talked about how there's limitations on time and how it would be better if we could keep the therapy in here in person, right, and not get really too excessive with the telephone calls. I realize that when you're in distress, there's that kind of feeling that it would be a good idea to call, but remember we discussed different levels of distress, and if it's something common that you've been through before and you kind of know the outcome, connecting with one of those resources might be more helpful.""
Patient: ""Yeah, I just feel like you're the only one that can help me. You know, I mean, my boyfriend, like, things aren't going well with him. I thought he could help me, but I guess he can't, and I think he's running around on me and all that. So I was just like, well, let me reach out to Dr. Grande and see if he can help me because it seems like my last resort. But""
Therapist: ""I remember you discussing a few weeks ago your boyfriend and you had a fairly high opinion of him. It seemed like a positive... Yeah, he was great.""",194.94,244.75
011_018,011,18,4,"Yeah, I mean, if he's not going to be faithful to me, what am I supposed to do? You know? I mean, it's just like every other guy that I've ever dated. Like, either leave me or cheat on me or lie to me. So, I mean, I don't know why I thought this one was going to be different. Seriously, why would this one be different?","Therapist: ""Yeah, I remember you seemed very excited about where that relationship could go.""
Patient: ""Yeah.""
Therapist: ""And you seem like you're much more negative about it now.""",255.02,275.51
011_020,011,20,4,"Yeah. I don't know if they were related, the text message and him leaving. I mean, but I just assumed so. I was going to assume because it seems to be a pattern in my life. You know, everybody lets me down.","Therapist: ""And you seem like you're much more negative about it now.""
Patient: ""Yeah, I mean, if he's not going to be faithful to me, what am I supposed to do? You know? I mean, it's just like every other guy that I've ever dated. Like, either leave me or cheat on me or lie to me. So, I mean, I don't know why I thought this one was going to be different. Seriously, why would this one be different?""
Therapist: ""So you have, you had this experience with the text message and you don't know, you don't know any more than that. But it sounds like you kind of jumped to, he's cheating. So you know you went to, had a text message and went to someone's house.""",293.05,304.48
011_022,011,22,4,"Probably. But I guess it's all I know. That's how I've always been treated. So I kind of feel like, why would this be different? Even though I thought it was in the beginning. But I don't know.","Therapist: ""So you have, you had this experience with the text message and you don't know, you don't know any more than that. But it sounds like you kind of jumped to, he's cheating. So you know you went to, had a text message and went to someone's house.""
Patient: ""Yeah. I don't know if they were related, the text message and him leaving. I mean, but I just assumed so. I was going to assume because it seems to be a pattern in my life. You know, everybody lets me down.""
Therapist: ""Could it be that you're jumping to that conclusion prematurely?""",309.51,324.76
011_024,011,24,4,"Yeah. I guess I just always pick the wrong people. Or it's probably just me. I think I'm the one that's just unlovable. I've been told that growing up a lot. So, I think it's to me. Because he's great. I mean, he's great. And he's good looking. He has a good job. And I always thought, I'm like, why is he with me? And then, now I see. Like, he doesn't really want to be with me. Whoever he was texting, that's probably the person who wants to be with him. She's probably pretty. She probably has a good job. She's got everything going for her. And so, hmm.","Therapist: ""Could it be that you're jumping to that conclusion prematurely?""
Patient: ""Probably. But I guess it's all I know. That's how I've always been treated. So I kind of feel like, why would this be different? Even though I thought it was in the beginning. But I don't know.""
Therapist: ""So you feel like you've seen this all before, this pattern?""",328.17,363.08
011_026,011,26,2,"No. I mean, when things are going bad in my relationships, they really seem to get to me, you know.","Therapist: ""So you feel like you've seen this all before, this pattern?""
Patient: ""Yeah. I guess I just always pick the wrong people. Or it's probably just me. I think I'm the one that's just unlovable. I've been told that growing up a lot. So, I think it's to me. Because he's great. I mean, he's great. And he's good looking. He has a good job. And I always thought, I'm like, why is he with me? And then, now I see. Like, he doesn't really want to be with me. Whoever he was texting, that's probably the person who wants to be with him. She's probably pretty. She probably has a good job. She's got everything going for her. And so, hmm.""
Therapist: ""So you really, this week at least, you don't seem to think a lot of yourself.""",370.83,379.44
011_028,011,28,2,"Yeah, I guess that's pretty right on. Yeah. I would say that.","Therapist: ""So you really, this week at least, you don't seem to think a lot of yourself.""
Patient: ""No. I mean, when things are going bad in my relationships, they really seem to get to me, you know.""
Therapist: ""So in a way you feel like your mood is subject to how your current romantic relationship is going.""",388.53,393.1
011_030,011,30,4,"No, I don't think so. I think it's everybody else that is treating me wrong. So unless I find the right person who's going to treat me right, then I don't know what I'm going to do.","Therapist: ""So in a way you feel like your mood is subject to how your current romantic relationship is going.""
Patient: ""Yeah, I guess that's pretty right on. Yeah. I would say that.""
Therapist: ""Is there anything that you can do from your side to improve what's going on?""",399.82,413.35
011_032,011,32,4,"Yeah. I think so. And like I said, I thought he was the right one in the beginning. And now I don't know anymore, but you know, I really don't want him to leave me because like then what am I going to do? Now I'm going to be alone. I want to be alone because I love them. But you know, so I think I probably will forgive them and just stay with them because I don't want to be alone. I'm too scared to do that. I mean, I don't want to be, um, alone without somebody, you know, I really need somebody. It's a fear of yours. Yes.","Therapist: ""Is there anything that you can do from your side to improve what's going on?""
Patient: ""No, I don't think so. I think it's everybody else that is treating me wrong. So unless I find the right person who's going to treat me right, then I don't know what I'm going to do.""
Therapist: ""So the key to feeling better is finding the right person.""",421.2,453.52
011_034,011,34,4,"Yes. I feel like I can't control their people's actions and that really makes me mad. That makes me really angry. You know, that what am I supposed to do? And so I think acting out and following them and checking their text messages is the only thing that makes me feel in control, I guess. I don't know.","Therapist: ""So the key to feeling better is finding the right person.""
Patient: ""Yeah. I think so. And like I said, I thought he was the right one in the beginning. And now I don't know anymore, but you know, I really don't want him to leave me because like then what am I going to do? Now I'm going to be alone. I want to be alone because I love them. But you know, so I think I probably will forgive them and just stay with them because I don't want to be alone. I'm too scared to do that. I mean, I don't want to be, um, alone without somebody, you know, I really need somebody. It's a fear of yours. Yes.""
Therapist: ""So does some of this seem, like what you're describing with your mood, does some of this seem like you're out of control?""",466.82,492.75
011_036,011,36,3,"Yeah. I mean, I can see that. I mean, people want you know, some that they can trust too. And I'm not sure I've always been honest with them, but I'm always looking for things that they're going to do to manipulate me or try to like, you know, screw me over or whatever. So I guess I can never let my guard down. Yeah, I'm suspicious.","Therapist: ""So does some of this seem, like what you're describing with your mood, does some of this seem like you're out of control?""
Patient: ""Yes. I feel like I can't control their people's actions and that really makes me mad. That makes me really angry. You know, that what am I supposed to do? And so I think acting out and following them and checking their text messages is the only thing that makes me feel in control, I guess. I don't know.""
Therapist: ""I know in the past when we've talked about this, you've mentioned that you thought that that behavior could be driving them away, too.""",504.2,530.76
011_038,011,38,4,"Yeah. Probably. But, I mean, like I said before, I don't want to be alone. I don't want to move out with somebody. I need somebody. I need somebody to be with. You know, I need somebody to help me with things. I don't want to be alone. You know, that's, you know, and he has said things to me like, you can't call me all the time at work because I'm at work and You leave me, like, 40 voice messages because I just want to know if he's actually at work. You know, and he's like, you can't do those things because I'm going to get fired. And then where were you going to be? And he's like, you know, and you can't, like, call the numbers in my phone and find out who they are and, like, hang up because my friends know it's you. And you can't, you know, have your friends come to the bar and see who I'm with and, like, report back to you. Like, he's like, I don't want to be in a relationship with someone that doesn't trust me like that. So now, you know, I'm really scared of losing him.","Therapist: ""I know in the past when we've talked about this, you've mentioned that you thought that that behavior could be driving them away, too.""
Patient: ""Yeah. I mean, I can see that. I mean, people want you know, some that they can trust too. And I'm not sure I've always been honest with them, but I'm always looking for things that they're going to do to manipulate me or try to like, you know, screw me over or whatever. So I guess I can never let my guard down. Yeah, I'm suspicious.""
Therapist: ""I wonder sometimes you acting on those suspicions, if that's not making things a little worse than those relationships.""",543.86,598.24
011_041,011,41,2,"Yeah, I just want to check up and see what they're doing, if they said they're at the place that they said they were going. You know, I just want to know that I'm not being lied to, because I've always been lied to. All my life I've been lied to, so.","Patient: ""Yeah. Probably. But, I mean, like I said before, I don't want to be alone. I don't want to move out with somebody. I need somebody. I need somebody to be with. You know, I need somebody to help me with things. I don't want to be alone. You know, that's, you know, and he has said things to me like, you can't call me all the time at work because I'm at work and You leave me, like, 40 voice messages because I just want to know if he's actually at work. You know, and he's like, you can't do those things because I'm going to get fired. And then where were you going to be? And he's like, you know, and you can't, like, call the numbers in my phone and find out who they are and, like, hang up because my friends know it's you. And you can't, you know, have your friends come to the bar and see who I'm with and, like, report back to you. Like, he's like, I don't want to be in a relationship with someone that doesn't trust me like that. So now, you know, I'm really scared of losing him.""
Therapist: ""Mm-hmm.""
Therapist: ""So you have called other boyfriends and this boyfriend many times.""",611.88,622.69
011_043,011,43,5,"Well, when I find out they're at the place that they said they were, then I feel better for at least, you know, for a few minutes. Until the next time, I'm like, wait. Well, maybe they left. Let me see where they are now. You know, and then it kind of builds upon itself until I just get so frustrated. And then, usually it ends with like a screaming match when I do see them. You know.","Therapist: ""So you have called other boyfriends and this boyfriend many times.""
Patient: ""Yeah, I just want to check up and see what they're doing, if they said they're at the place that they said they were going. You know, I just want to know that I'm not being lied to, because I've always been lied to. All my life I've been lied to, so.""
Therapist: ""Is all that calling something you do to relieve anxiety?""",627.67,649.44
011_045,011,45,3,"A lot of screaming and yelling and accusations and finger pointing and Just, yeah, it's not good. It's not a good scene. No. When those kinds of things go down. But, like I said, I really love him. I don't want to be without him. I don't know how I would live without him.","Therapist: ""Is all that calling something you do to relieve anxiety?""
Patient: ""Well, when I find out they're at the place that they said they were, then I feel better for at least, you know, for a few minutes. Until the next time, I'm like, wait. Well, maybe they left. Let me see where they are now. You know, and then it kind of builds upon itself until I just get so frustrated. And then, usually it ends with like a screaming match when I do see them. You know.""
Therapist: ""So there's a lot of screaming and yelling.""",651.78,671.62
011_047,011,47,5,"I said I would do whatever it took for him to stay with me. He doesn't really talk about it. I think he gets really mad for being so needy. He's like, you're needy. Why don't you do your own stuff and leave me alone? You need to have your own life. I don't like to be ignored. I was ignored all growing up. We had a big family. I just got lost in the shuffle. And now here I am.","Therapist: ""So there's a lot of screaming and yelling.""
Patient: ""A lot of screaming and yelling and accusations and finger pointing and Just, yeah, it's not good. It's not a good scene. No. When those kinds of things go down. But, like I said, I really love him. I don't want to be without him. I don't know how I would live without him.""
Therapist: ""All right, so there's screaming and there's yelling and some discontentment, but there's also this love you have for him and this fear that you'll be alone. Mm-hmm. Yeah. So there's a lot of emotion here driving different behaviors.""",691.91,724.16
011_049,011,49,3,"Well, I guess I would like to be able to trust people more. and not feel so desperate. I mean, that's, and I don't know what to do. I don't know how to do that.","Therapist: ""All right, so there's screaming and there's yelling and some discontentment, but there's also this love you have for him and this fear that you'll be alone. Mm-hmm. Yeah. So there's a lot of emotion here driving different behaviors.""
Patient: ""I said I would do whatever it took for him to stay with me. He doesn't really talk about it. I think he gets really mad for being so needy. He's like, you're needy. Why don't you do your own stuff and leave me alone? You need to have your own life. I don't like to be ignored. I was ignored all growing up. We had a big family. I just got lost in the shuffle. And now here I am.""
Therapist: ""So with all these things going on, with all these kind of negative feelings, negative self-image, and trouble with the boyfriend, like this week, today, what's your goal? What do you want to change?""",742.52,756.22
011_051,011,51,4,"Yeah. I mean, that's what they say the problem is. But I don't know. It could be something else. I mean, it could be somebody else. They could have met somebody better. I don't know. That's what they tell me. Maybe they're trying to be nice, trying to get out of the relationship. There's no way to know.","Therapist: ""So with all these things going on, with all these kind of negative feelings, negative self-image, and trouble with the boyfriend, like this week, today, what's your goal? What do you want to change?""
Patient: ""Well, I guess I would like to be able to trust people more. and not feel so desperate. I mean, that's, and I don't know what to do. I don't know how to do that.""
Therapist: ""To be able to trust people more. So maybe one place we could start is to ensure that you're accurately assessing what, for example, your boyfriend's doing, right? So in the past when we've talked, you've been suspicious about different behaviors and it turns out In many of those cases, nothing was happening. Yeah. And the kind of chasing them around and making observations, that's what caused some of the problem. Does that make sense?""",793.83,808.9
011_053,011,53,5,"Yeah, I don't feel good. I mean, I feel completely anxious when I do it for, A, I might get caught. You know, that's always a thing in my mind. And, like, B, like, why am I doing this? But it's something beyond my control sometimes. I just need to know.","Therapist: ""To be able to trust people more. So maybe one place we could start is to ensure that you're accurately assessing what, for example, your boyfriend's doing, right? So in the past when we've talked, you've been suspicious about different behaviors and it turns out In many of those cases, nothing was happening. Yeah. And the kind of chasing them around and making observations, that's what caused some of the problem. Does that make sense?""
Patient: ""Yeah. I mean, that's what they say the problem is. But I don't know. It could be something else. I mean, it could be somebody else. They could have met somebody better. I don't know. That's what they tell me. Maybe they're trying to be nice, trying to get out of the relationship. There's no way to know.""
Therapist: ""That seems to be where your mind goes first. It's kind of the worst case or one of the worst case scenarios. So sometimes with managing mood, one of the keys to success is encouraging accurate thinking, logical thinking. So there's a lot of emotion involved when you're following them around and when you're checking the cell phone? Like, are you feeling strong emotions?""",842.62,860.11
011_055,011,55,4,"Yeah, it compounds itself, definitely.","Therapist: ""That seems to be where your mind goes first. It's kind of the worst case or one of the worst case scenarios. So sometimes with managing mood, one of the keys to success is encouraging accurate thinking, logical thinking. So there's a lot of emotion involved when you're following them around and when you're checking the cell phone? Like, are you feeling strong emotions?""
Patient: ""Yeah, I don't feel good. I mean, I feel completely anxious when I do it for, A, I might get caught. You know, that's always a thing in my mind. And, like, B, like, why am I doing this? But it's something beyond my control sometimes. I just need to know.""
Therapist: ""Would it be possible to... you have these thoughts like that say let's work on this idea that you're worried about him cheating right so you have this thought that something like he's going to leave me he doesn't really love me he's cheating is that close to what you're thinking yeah that's pretty close and after you have a thought like that are you Is that when you're like checking up on him and checking on his phone?""",897.97,902.81
011_062,011,62,4,"Yeah, sometimes I don't even know what I'm doing. I just, like, find myself in the car. I'm like, where am I going? I'm like, what am I doing, you know?","Patient: ""That's going to be hard.""
Therapist: ""It's difficult, yeah.""
Therapist: ""I know sometimes it feels like the emotion kind of takes charge.""",974.56,984.89
011_066,011,66,2,"Yeah, I really feel rejected when that happens.","Therapist: ""Yeah, the emotions are powerful. However, I'd like to be able to get these thoughts. I think that there might be a way to improve your mood if we can find out how these thoughts are working and maybe try to make some adjustments there. I know it's difficult and I know the emotions are hard to control for you. Do you think that's a step you could try this week though? And so whenever you find yourself about to do something, that's maybe going to antagonize the situation, write down at that point what you're thinking.""
Patient: ""Okay. Right? Do it.""
Therapist: ""Maybe that way you can kind of channel some energy there and not act out on that. And it's also something we can take a look at in session next time and review those thoughts. Okay. See what we find. See if we find any patterns. Okay. Does that make sense? Mm-hmm. I know this is a struggle for you, and I realize that writing all these thoughts down and following this process is new and different. I want you to try to stick with it if you can. I think that you could be able to benefit from this if you could stick with it. Okay. All right? Try. Okay, give it a try? Mm-hmm. All right, Marcy. Let's go with that plan and write down those thoughts. We'll go over them next week. And between now and next week, the same thing, like in terms of when you want to reach out to me, take a look at those guidelines we've worked out with that process and work through the process and see if you're actually supposed to contact me, if it's really something that requires that attention, or if some of your supports can take care of that. All right? I know it's tough when you call me and I can't get back to you.""",1110.47,1114.47
012_003,012,3,4,"Well, you know, I have two jobs. And I lost one of them.","Therapist: ""Hello, Jordan. How are you doing today?""
Patient: ""Could have been better.""
Therapist: ""Could be better?""",22.98,27.66
012_009,012,9,5,Me too. And I'm just... It's all I think about now.,"Patient: ""I lost one at the grocery store.""
Therapist: ""That was your part-time?""
Therapist: ""I'm sorry to hear that.""",38.75,44.26
012_011,012,11,4,"It happened about two, three days ago.","Therapist: ""I'm sorry to hear that.""
Patient: ""Me too. And I'm just... It's all I think about now.""
Therapist: ""And when did this happen?""",46.55,49.33
012_015,012,15,2,"It's not, but I mean, I'm still very worried about it.","Therapist: ""Two, three days ago? Yeah. So if I remember right, you took that job not too long ago to kind of supplement your income.""
Patient: ""Yeah.""
Therapist: ""So certainly that would be upsetting, but I know that's not a major part of your income.""",65.62,68.47
012_017,012,17,4,"I mean, I worry that, you know, I'm now I only had so much money and now I have less than that. I mean, without my money, you know, God knows how many things can happen.","Therapist: ""So certainly that would be upsetting, but I know that's not a major part of your income.""
Patient: ""It's not, but I mean, I'm still very worried about it.""
Therapist: ""Tell me about the worry.""",71.59,82.75
012_019,012,19,2,"I was doing okay, but I mean, I got comfortable with that extra income and so now my fear is that I've gotten too comfortable with it and now that it's not there anymore, it's going to affect the fact, you know, I'm not going to be able to pay for food or my rent.","Therapist: ""Tell me about the worry.""
Patient: ""I mean, I worry that, you know, I'm now I only had so much money and now I have less than that. I mean, without my money, you know, God knows how many things can happen.""
Therapist: ""So before you had the job, you were paying all your bills, you wanted some extra income, you've lost that extra income, and I can certainly understand how that would be disturbing. But as I understand it, you were doing okay before with your full-time job.""",99.89,118.33
012_021,012,21,4,"I'm worried that I mean, things are just going to get worse from here. I mean, it's a big deal losing your job, even if it was part-time. I've gotten comfortable from having so much money, the money I had, to now that's, you know, been divided. And I mean, God knows how many things, like I said, God knows how many things can happen.","Therapist: ""So before you had the job, you were paying all your bills, you wanted some extra income, you've lost that extra income, and I can certainly understand how that would be disturbing. But as I understand it, you were doing okay before with your full-time job.""
Patient: ""I was doing okay, but I mean, I got comfortable with that extra income and so now my fear is that I've gotten too comfortable with it and now that it's not there anymore, it's going to affect the fact, you know, I'm not going to be able to pay for food or my rent.""
Therapist: ""Okay, so you adjusted to the new income level with the full-time and the part-time job together and you're worried you can't adjust back?""",132.29,152.42
012_023,012,23,5,"Well... I can, you know, stay in the mindset that I have that extra money and spend what I think is that extra money, digging into the money I paid for my rent, my food, my gas, my insurance. I mean, who's somebody without all that?","Therapist: ""Okay, so you adjusted to the new income level with the full-time and the part-time job together and you're worried you can't adjust back?""
Patient: ""I'm worried that I mean, things are just going to get worse from here. I mean, it's a big deal losing your job, even if it was part-time. I've gotten comfortable from having so much money, the money I had, to now that's, you know, been divided. And I mean, God knows how many things, like I said, God knows how many things can happen.""
Therapist: ""Well, what can happen? So your income's reduced now to just your full-time job. Mm-hmm. What can happen from this point on?""",162.99,181.25
012_025,012,25,3,"And they help me go to my full-time job. that, you know, that I still have. So, I mean, if I can't, if I spend the money that was from my insurance because I thought I had extra, then I'm not going to have insurance on my car. I can get pulled over, lose my license. I'm not going to be able to get to work. And then I'll get fired there, too.","Therapist: ""Well, what can happen? So your income's reduced now to just your full-time job. Mm-hmm. What can happen from this point on?""
Patient: ""Well... I can, you know, stay in the mindset that I have that extra money and spend what I think is that extra money, digging into the money I paid for my rent, my food, my gas, my insurance. I mean, who's somebody without all that?""
Therapist: ""So you could fail to pay expenses that need to be paid.""",189.82,214.3
012_027,012,27,5,Which is just more money I don't have.,"Therapist: ""So you could fail to pay expenses that need to be paid.""
Patient: ""And they help me go to my full-time job. that, you know, that I still have. So, I mean, if I can't, if I spend the money that was from my insurance because I thought I had extra, then I'm not going to have insurance on my car. I can get pulled over, lose my license. I'm not going to be able to get to work. And then I'll get fired there, too.""
Therapist: ""All right. So the kind of chain of causality you're seeing is that without that part-time income, You might not adapt with your expense management. You might fail to pay, for example, your car insurance. You could get pulled over for something. The police officer could see you don't have insurance, give you a ticket.""",235.94,238.09
012_031,012,31,4,"Well, the ticket would be expensive, so I wouldn't be able to try to pay the next month's insurance, so I just wouldn't have insurance on my car.","Therapist: ""Another expense, right? And how would that connect to losing your job?""
Patient: ""Because I wouldn't be able to get to work.""
Therapist: ""So the ticket would be so expensive you would lose your job?""",252.21,260.38
012_035,012,35,4,"I mean, it's either go to work with an uninsured car, and then I can get pulled over and go to jail for driving with no insurance multiple times.","Therapist: ""So you'd lose your insurance.""
Patient: ""I'd lose my insurance.""
Therapist: ""And then by losing your insurance, you'd lose your transportation altogether because you can't drive to insurance, and then you'd lose your job.""",269.77,278.56
012_039,012,39,4,"Yes. Yeah. I mean, which I would definitely lose my job if I'm in jail.","Therapist: ""That's serious.""
Patient: ""I would last in jail.""
Therapist: ""So there's two, so you have two kind of causal chains. One is losing your job and now even just the idea can end up incarcerated.""",292.31,296.77
012_041,012,41,5,"And so that would have, so then I wouldn't even have like any money to help me through jail. Like to, for the commissary and stuff.","Therapist: ""So there's two, so you have two kind of causal chains. One is losing your job and now even just the idea can end up incarcerated.""
Patient: ""Yes. Yeah. I mean, which I would definitely lose my job if I'm in jail.""
Therapist: ""I would imagine.""",298.86,308.75
012_043,012,43,4,"I would have no income. And then when I get out of jail, No one's going to hire me.","Therapist: ""I would imagine.""
Patient: ""And so that would have, so then I wouldn't even have like any money to help me through jail. Like to, for the commissary and stuff.""
Therapist: ""Because you would have no income.""",309.79,314.44
012_045,012,45,4,from it was like a late notice but it wasn't it turned out it wasn't you know it was sent to me but it was somebody else's credit card it was a mistake right yeah do you remember the conclusions you drew from when you believed that was actually for you that that late notice that my credit score was going to go down that i would i'd be stuck in that apartment and then i'd go into depression i wouldn't be able to do anything,"Therapist: ""Because you would have no income.""
Patient: ""I would have no income. And then when I get out of jail, No one's going to hire me.""
Therapist: ""Because you have a criminal record. Exactly. Which makes it challenging to find employment in some instances. So what's happened is kind of in your mind, and we've talked about how thoughts work and beliefs work, is you, in reality, you've lost this part-time job. And as I said, certainly that's understandable that you'd be upset about that, right? I doubt many people would be happy about losing additional income. But you move from there, from losing additional income, which is what has actually happened, to this possibility that you could be in jail or lose your job because of this. So I remember maybe last week, the week before, you were talking about the letter that you received.""",372.42,399.07
012_047,012,47,2,"I mean, I've seen that, you know, sometimes I can think the worst. And I know it didn't happen last time, but that was, you know, a stroke of good luck.","Therapist: ""Because you have a criminal record. Exactly. Which makes it challenging to find employment in some instances. So what's happened is kind of in your mind, and we've talked about how thoughts work and beliefs work, is you, in reality, you've lost this part-time job. And as I said, certainly that's understandable that you'd be upset about that, right? I doubt many people would be happy about losing additional income. But you move from there, from losing additional income, which is what has actually happened, to this possibility that you could be in jail or lose your job because of this. So I remember maybe last week, the week before, you were talking about the letter that you received.""
Patient: ""from it was like a late notice but it wasn't it turned out it wasn't you know it was sent to me but it was somebody else's credit card it was a mistake right yeah do you remember the conclusions you drew from when you believed that was actually for you that that late notice that my credit score was going to go down that i would i'd be stuck in that apartment and then i'd go into depression i wouldn't be able to do anything""
Therapist: ""Yeah, so you ended up in that scenario, you ended up in a situation where you just couldn't function at all. Yeah. And you moved there from a letter that you believe was addressed to you saying you were one month or 60 days late or something on a credit card, which of course you don't want to be late on a credit card, but you moved from there to being so depressed you couldn't work, couldn't function. I think that's how you put it, couldn't function. Yeah. Do you see, kind of given how we've talked about cognitive behavioral strategies and concepts, do you see a pattern that's emerged over the last few times I've seen you?""",442.65,455.27
012_049,012,49,2,"Yeah, that it wasn't me. That was a relief. But this is something that's solid. I don't have my part-time job anymore.","Therapist: ""Yeah, so you ended up in that scenario, you ended up in a situation where you just couldn't function at all. Yeah. And you moved there from a letter that you believe was addressed to you saying you were one month or 60 days late or something on a credit card, which of course you don't want to be late on a credit card, but you moved from there to being so depressed you couldn't work, couldn't function. I think that's how you put it, couldn't function. Yeah. Do you see, kind of given how we've talked about cognitive behavioral strategies and concepts, do you see a pattern that's emerged over the last few times I've seen you?""
Patient: ""I mean, I've seen that, you know, sometimes I can think the worst. And I know it didn't happen last time, but that was, you know, a stroke of good luck.""
Therapist: ""That it wasn't you.""",456.47,464.54
012_051,012,51,4,"I mean, this isn't a mistake. This isn't a, we fired the wrong person. You know, this is... real. So there's real concerns here. Unlike last time where I was lucky.","Therapist: ""That it wasn't you.""
Patient: ""Yeah, that it wasn't me. That was a relief. But this is something that's solid. I don't have my part-time job anymore.""
Therapist: ""You've lost real income.""",467.31,477.85
012_055,012,55,4,"Well, I suppose there is, but I'm concerned about whether I'm not, whether I won't adapt.","Therapist: ""So this, this situation you see is different than the first situation because the first situation was more you were perceiving something was wrong that wasn't wrong because you weren't the intended recipient of the letter.""
Patient: ""Yeah.""
Therapist: ""But this situation is different because it's real. You really lost your income. Yeah. And of course, keeping in mind that this job, again, only a few months old, and you survived well before that, is there a reason to believe you could survive well again, that you could adapt to this lost income?""",516.29,523.18
012_059,012,59,2,"Not yet. But I mean, I struggled a little bit when I lost a part-time job or when I was younger and I had those little jobs.","Therapist: ""Well, let's look at this in terms of probabilities. You've had several jobs throughout your career. You've had some of them worked out. You've lost other ones. You're still paying your bills. So in terms of probabilities, how many times have you ended up in jail or losing your full-time job?""
Patient: ""I mean, they haven't happened yet.""
Therapist: ""It hasn't happened.""",550.11,560.18
012_064,012,64,1,"Yeah. I mean, but I'm older now, and these are, you know, even though grocery store's not a serious job, it was income. Sure.","Therapist: ""And it was painful.""
Patient: ""I did struggle a little bit.""
Therapist: ""Yeah, you struggled.""",567.53,576.38
012_066,012,66,1,"I suppose I have more time to focus on my full-time job because, I mean, that is really intensive.","Therapist: ""Yeah, you struggled.""
Patient: ""Yeah. I mean, but I'm older now, and these are, you know, even though grocery store's not a serious job, it was income. Sure.""
Therapist: ""Yeah. And again, to lose income would be disappointing for just about anybody. Are there any upsides to not having that job?""",587.06,592.94
012_068,012,68,2,"I mean, because... will somebody else take me because I was fired from that job? I mean, that's my concern, is that nobody...","Therapist: ""Yeah. And again, to lose income would be disappointing for just about anybody. Are there any upsides to not having that job?""
Patient: ""I suppose I have more time to focus on my full-time job because, I mean, that is really intensive.""
Therapist: ""Is there a possibility that you could find another part-time job just as you found that one?""",603.18,611.41
012_070,012,70,4,"Yeah, and then they're going to go, oh, she was fired, you know, we don't want her.","Therapist: ""Is there a possibility that you could find another part-time job just as you found that one?""
Patient: ""I mean, because... will somebody else take me because I was fired from that job? I mean, that's my concern, is that nobody...""
Therapist: ""They're going to find out about that?""",613.73,616.85
012_074,012,74,4,"No, not even close. I know that. I don't think about the positive things. I mean, I don't get fired and then go, what's good about this?","Therapist: ""But you've had other jobs that didn't work out before, and that didn't affect you getting that job. That's true. So the worst case scenario, I guess what I'm getting at, the worst case scenario is, in your case, ending up in jail or losing your full-time job, which you've had for a while.""
Patient: ""Yeah, I really don't want to lose my job.""
Therapist: ""And it seems like they like you there. I hope they do. Pretty well, right? Yeah. So those scenarios, I guess, are possible. they seem, based on what you're saying, it's pretty unlikely. So I wonder how useful it is to invest a lot of energy in kind of tracking that causal chain to jail or prison or to unemployment when that's really not the most likely outcome. Like do you invest, sorry to interrupt you, but do you invest as much energy in tracking the positives or the probable outcomes.""",679.01,689.73
012_076,012,76,2,"Yeah. Yeah, no, that's pretty accurate.","Therapist: ""And it seems like they like you there. I hope they do. Pretty well, right? Yeah. So those scenarios, I guess, are possible. they seem, based on what you're saying, it's pretty unlikely. So I wonder how useful it is to invest a lot of energy in kind of tracking that causal chain to jail or prison or to unemployment when that's really not the most likely outcome. Like do you invest, sorry to interrupt you, but do you invest as much energy in tracking the positives or the probable outcomes.""
Patient: ""No, not even close. I know that. I don't think about the positive things. I mean, I don't get fired and then go, what's good about this?""
Therapist: ""Or get a letter in the mail and say, although I can see there's not much upside to that, although it turned out that was an error. But this has still been a theme. that I've seen over the last eight to ten weeks, where you really have, you really emphasize the negative possible, even unlikely outcomes, kind of expanding the negative as you move through like a causal chain. Yeah. Does that make sense? Yeah. But you don't do the same thing for the positive side. You don't look at how something could work out well. Would you say that's a fair assessment?""",734.95,737.76
012_078,012,78,2,"I mean, yeah, I am worried. I'm not going to be thrilled about it. But I suppose I don't have to go to, you know, I'm going to go to jail or I'm going to lose my full-time job.","Therapist: ""Or get a letter in the mail and say, although I can see there's not much upside to that, although it turned out that was an error. But this has still been a theme. that I've seen over the last eight to ten weeks, where you really have, you really emphasize the negative possible, even unlikely outcomes, kind of expanding the negative as you move through like a causal chain. Yeah. Does that make sense? Yeah. But you don't do the same thing for the positive side. You don't look at how something could work out well. Would you say that's a fair assessment?""
Patient: ""Yeah. Yeah, no, that's pretty accurate.""
Therapist: ""But still you're worried about this?""",740.82,750.4
012_080,012,80,1,"I mean, I suppose I could get, you know, a family member to drive me or take the bus if I lost my insurance and lost my car.","Therapist: ""But still you're worried about this?""
Patient: ""I mean, yeah, I am worried. I'm not going to be thrilled about it. But I suppose I don't have to go to, you know, I'm going to go to jail or I'm going to lose my full-time job.""
Therapist: ""I think there's a lot of intervening factors that could occur before going to jail or losing your job. There's other things that you could do.""",761.41,768.34
012_082,012,82,2,"I guess I can keep, you know, better track of how much I do spend and, you know, keep track of my bank accounts and exactly how much money I have in them.","Therapist: ""I think there's a lot of intervening factors that could occur before going to jail or losing your job. There's other things that you could do.""
Patient: ""I mean, I suppose I could get, you know, a family member to drive me or take the bus if I lost my insurance and lost my car.""
Therapist: ""So alternate forms of transportation, yeah. There's adapting your spending back to where it was before. That's true. Part of your fear was that you wouldn't be able to adapt your spending, right? But that's something you would have control over.""",783.78,793.4
012_086,012,86,2,"I mean, knowing that I'm thinking about it wrong makes me feel a little better.","Therapist: ""So having talked through this a little bit, right, what I'm going to refer to or is referred to as catastrophizing, remember we talked about that when we reviewed the cognitive distortions?""
Patient: ""That sounds familiar, yeah.""
Therapist: ""Where the negative is taken and just make it way more negative than it is at the moment, right? Kind of knowing that that tends to be what you do, It's what we call an error in thinking that you tend to make. Does that lower your anxiety about the situation? Does it change it in some way?""",829.06,835.11
012_088,012,88,1,"Okay. That actually makes me feel better. Knowing that these things can happen, but They might not. There's other things that can happen before them.","Therapist: ""Where the negative is taken and just make it way more negative than it is at the moment, right? Kind of knowing that that tends to be what you do, It's what we call an error in thinking that you tend to make. Does that lower your anxiety about the situation? Does it change it in some way?""
Patient: ""I mean, knowing that I'm thinking about it wrong makes me feel a little better.""
Therapist: ""I would say you're thinking about it in a way that's less than useful.""",841.07,854.44
012_090,012,90,2,Yeah.,"Therapist: ""I would say you're thinking about it in a way that's less than useful.""
Patient: ""Okay. That actually makes me feel better. Knowing that these things can happen, but They might not. There's other things that can happen before them.""
Therapist: ""Yeah, I mean, I would even say probably not.""",858.53,861.13
012_092,012,92,2,"People weaker than me have gone through jail, I guess.","Therapist: ""Yeah, I mean, I would even say probably not.""
Patient: ""Yeah.""
Therapist: ""So, one way, potentially, and there's a few things we can review over the next few sessions. One way to address catastrophizing, in addition to the adaptive responses, which we've talked about before, would be to find some sort of peace with the worst outcome, meaning you kind of take away the power of that anxiety over you when you can accept the worst possible outcomes. It doesn't mean you look forward to them or you think they're likely or you dwell on them and ponder them. But, I mean, obviously being in jail, even though it's an extremely low probability event in your circumstance, Being in jail would be survivable. Being unemployed would be survivable.""",913.42,917.71
012_094,012,94,2,That makes me feel better. They're thinking about me as a survivor.,"Therapist: ""So, one way, potentially, and there's a few things we can review over the next few sessions. One way to address catastrophizing, in addition to the adaptive responses, which we've talked about before, would be to find some sort of peace with the worst outcome, meaning you kind of take away the power of that anxiety over you when you can accept the worst possible outcomes. It doesn't mean you look forward to them or you think they're likely or you dwell on them and ponder them. But, I mean, obviously being in jail, even though it's an extremely low probability event in your circumstance, Being in jail would be survivable. Being unemployed would be survivable.""
Patient: ""People weaker than me have gone through jail, I guess.""
Therapist: ""A lot of people have been to jail. A lot of people have lost their jobs. And while it's certainly a struggle, to use your word, right? I mean, that would be more than a struggle. It would be quite unpleasant. It's at the point where you can accept that that could happen and that you would survive. that you could find some peace with the catastrophizing. Again, we'll have other routes. We'll attack these cognitive distortions from a few different angles. But one of the angles is reaching a point where you could accept that those things could happen, they're unlikely, they could happen, and you would survive. Okay. I mean, one thing you've shown throughout your, I mean, based on what you've described to me is that you're a survivor. You find a way to make it work.""",967.76,971.7
012_096,012,96,2,"I'm right in thinking that that's not a good thing, losing my job.","Therapist: ""A lot of people have been to jail. A lot of people have lost their jobs. And while it's certainly a struggle, to use your word, right? I mean, that would be more than a struggle. It would be quite unpleasant. It's at the point where you can accept that that could happen and that you would survive. that you could find some peace with the catastrophizing. Again, we'll have other routes. We'll attack these cognitive distortions from a few different angles. But one of the angles is reaching a point where you could accept that those things could happen, they're unlikely, they could happen, and you would survive. Okay. I mean, one thing you've shown throughout your, I mean, based on what you've described to me is that you're a survivor. You find a way to make it work.""
Patient: ""That makes me feel better. They're thinking about me as a survivor.""
Therapist: ""Right, so in a sense, kind of reframing, we talked about that before too, right? Your circumstances as you're somebody that's surviving adversity. Losing a job is, we talked about it, a negative thing.""",987.05,990.48
012_103,012,103,4,Okay.,"Therapist: ""In a way, it almost increases its likelihood because you're...""
Patient: ""I'm thinking about it too much.""
Therapist: ""You're investing in the negative outcomes without really looking at the positive side.""",1061.13,1063.58
012_105,012,105,1,"Because I wanted to invest all my time in my full-time job, but it's always nice to have some extra spending money, especially with the holidays coming up.","Therapist: ""You're investing in the negative outcomes without really looking at the positive side.""
Patient: ""Okay.""
Therapist: ""So that's kind of how cognitive distortions work, right? They're consistent errors in thinking. And we'll work on helping you to reframe circumstances like this. Okay. Granted, this is certainly more distressing than receiving that letter A little bit. Yeah. But I remember when you were talking about, a while back, when you were talking about getting the part-time job, you were unsure if you really wanted to take the time and do it. You were kind of on the fence back then about taking it.""",1095.41,1105.06
012_107,012,107,2,"I mean, it seems like that there's better ways to go about it than thinking, I'm going to go to jail, I'm going to be unemployed forever.","Therapist: ""So that's kind of how cognitive distortions work, right? They're consistent errors in thinking. And we'll work on helping you to reframe circumstances like this. Okay. Granted, this is certainly more distressing than receiving that letter A little bit. Yeah. But I remember when you were talking about, a while back, when you were talking about getting the part-time job, you were unsure if you really wanted to take the time and do it. You were kind of on the fence back then about taking it.""
Patient: ""Because I wanted to invest all my time in my full-time job, but it's always nice to have some extra spending money, especially with the holidays coming up.""
Therapist: ""Sure. So you were on the fence, but you decided to go with it. It didn't work out. So you can revisit and try to find another part-time job, or you can go back to the other strategies you were looking at before, invest more energy in your full-time work. There's some things you want to do in your spare time you had mentioned, you know, kind of recreationally. So it's not good news, but if you look at it in terms of the whole context, you weren't that thrilled about that job in the first place. You had other possibilities. Investing in those could be a route. I'm trying to give you more options than just the catastrophic ones.""",1145.09,1155.22
012_109,012,109,2,"Yeah, I suppose it's not hard to get it. grocery store job again.","Therapist: ""Sure. So you were on the fence, but you decided to go with it. It didn't work out. So you can revisit and try to find another part-time job, or you can go back to the other strategies you were looking at before, invest more energy in your full-time work. There's some things you want to do in your spare time you had mentioned, you know, kind of recreationally. So it's not good news, but if you look at it in terms of the whole context, you weren't that thrilled about that job in the first place. You had other possibilities. Investing in those could be a route. I'm trying to give you more options than just the catastrophic ones.""
Patient: ""I mean, it seems like that there's better ways to go about it than thinking, I'm going to go to jail, I'm going to be unemployed forever.""
Therapist: ""Sure, there's ways that are more useful to you to probably help you dig out of this faster and either adjust to not having the income or replace the income.""",1167.13,1170.6
012_115,012,115,2,Do the best for me. Sure.,"Therapist: ""And again, even if it is hard, it's a struggle, you survived on that other income for a long time without that. So when you have, and we'll talk about this next time, we can develop some adaptive responses for some of these automatic thoughts that are coming up. So we'll try to identify some of the automatic thoughts that are coming up around the job loss. But for now, I want you to just try to get a general understanding of the theme, which is that you tend to catastrophize. And it is what it is, but it's not so useful for you in terms of your most efficient productive function. It's not bad or good, it's just not particularly useful.""
Patient: ""Yeah, it's not the best I could do.""
Therapist: ""And you want to try to""",1229.63,1231.73
012_120,012,120,2,"Yeah, it does. All right.","Patient: ""Yeah, it does.""
Therapist: ""So think about that theme, right? And think about the reframe we talked about where you're a survivor, because actually I think that's accurate. You're a survivor. And I want you to focus on those two elements for this week. And then next week when we meet, we'll talk about the... the automatic thoughts. We'll start identifying those and breaking that down like we did that before.""
Therapist: ""To develop the adaptive responses. Does that sound like a plan?""",1269.97,1272.48
013_001,013,1,2,"I'm good, but there has been an issue. You know how we've been working on, like, my motivation? Sure. Well, it's kind of related to that. So I'm in school, and every few weeks we have, like, papers to write. And I know I know it. I know I can do it. It's just actually sitting down and doing it.","Therapist: ""Hi, Lisa. How are you doing today?""",16.1,38.72
013_003,013,3,4,"Well, they're usually about five pages long. And I just look at it and I'm like, it's five pages. But I'm like, okay, so I go sit down at my computer. I'm like, all right, I'm going to start on references. So I get, you know, I start off good. I do the references, but then it's like I get sidetracked so easily. And then I end up killing like two hours checking the news, checking, and then it goes to my phone and then, just looking at recipes. I mean, it gets really off topic. And then I realized, you know, I haven't done anything.","Therapist: ""Hi, Lisa. How are you doing today?""
Patient: ""I'm good, but there has been an issue. You know how we've been working on, like, my motivation? Sure. Well, it's kind of related to that. So I'm in school, and every few weeks we have, like, papers to write. And I know I know it. I know I can do it. It's just actually sitting down and doing it.""
Therapist: ""All right. Well, tell me about the papers.""",41.63,76.31
013_007,013,7,4,"Well, I get kind of and you're annoyed with it. And I'm like, well, you know, I've already, you know, it's already nighttime. I'll try to do it tomorrow. And then, you know, either tomorrow doesn't happen or the same thing happens. And it's just, and then I end up, you know, rushing right at the end to, you know, to do tomorrow and I'm getting all these five pages done. It's really hard for me.","Therapist: ""All right. So you have a five-page paper. You sit down to work on it. You have the references. You get that part taken care of. But then it sounds like you kind of wander off a little bit.""
Patient: ""Oh, big time.""
Therapist: ""Yeah. Okay. And then what happens after you are done wandering a little bit?""",97.15,119.93
013_013,013,13,4,"No, I mean, I try not to. I mean, I set time aside to go sit down. I'm like, all right, you know, we're going to start on this paper. Then sidetracked. I'm watching TV. I'm on my phone. I'm on some other website.","Patient: ""It's just all at the last minute.""
Therapist: ""So it's really how the time breaks out isn't working out well for you.""
Therapist: ""You'd rather not be doing it at the last moment.""",140.26,154.43
013_015,013,15,2,"Yeah. I mean, there's small things that keep my attention, but that's not where my attention needs to go.","Therapist: ""You'd rather not be doing it at the last moment.""
Patient: ""No, I mean, I try not to. I mean, I set time aside to go sit down. I'm like, all right, you know, we're going to start on this paper. Then sidetracked. I'm watching TV. I'm on my phone. I'm on some other website.""
Therapist: ""So these activities that you're engaging in between when you start the work and before you start writing, so we're gathering the references before you start writing. You said check an email. Yeah. And other kind of, it sounds like, unplanned small activities.""",178.07,184.48
013_017,013,17,2,"No, I mean, I look up, you know, I start on one reference and then, ooh, this article looks cool, ooh, this article, you know, next thing I know I'm researching octopuses or something.","Therapist: ""So these activities that you're engaging in between when you start the work and before you start writing, so we're gathering the references before you start writing. You said check an email. Yeah. And other kind of, it sounds like, unplanned small activities.""
Patient: ""Yeah. I mean, there's small things that keep my attention, but that's not where my attention needs to go.""
Therapist: ""These aren't particularly engaging activities, like something you need to do at that moment?""",190.58,200.45
013_027,013,27,1,"you enjoy doing a little but they're not something that I mean they're not something I'm jumping for joy about it's just something to procrastinate so I don't have to do my paper and I don't think that you know I'm not like oh I need to check my email so I don't have to do my paper it's just oh I should check my email oh I should check my phone oh I haven't done this in a while oh I haven't seen this in a while but these behaviors still fulfill purpose they do delay the writing of the paper Yeah, that's true.","Therapist: ""You collect the material, and then the writing part.""
Patient: ""That's the difficult part.""
Therapist: ""And then you have these behaviors in the middle, which""",242.33,273.42
013_031,013,31,2,"Well, there is this new TV show out that they just started a new season. And I have it all recorded, like 24 episodes. But I can't find time to watch it. But I'm really, you know, I've seen the first season. I'm so interested in it. I can't wait to see the next one. I guess that's what makes me really happy right now.","Therapist: ""You may not be fully aware of that in the moment, but then you kind of become aware of that later, that that's the purpose that those behaviors accomplished.""
Patient: ""Yeah.""
Therapist: ""Was that they kept you distracted from the writing. That's true. All right. So the writing of papers and activity, that's a behavior that's something you're not really looking forward to. What's a behavior that, what's an activity that you really do look forward to? That you kind of think about and some level of engagement is there?""",310.98,333.43
013_033,013,33,4,"Yeah. I mean, this paper's taking me a lot longer than it should.","Therapist: ""Was that they kept you distracted from the writing. That's true. All right. So the writing of papers and activity, that's a behavior that's something you're not really looking forward to. What's a behavior that, what's an activity that you really do look forward to? That you kind of think about and some level of engagement is there?""
Patient: ""Well, there is this new TV show out that they just started a new season. And I have it all recorded, like 24 episodes. But I can't find time to watch it. But I'm really, you know, I've seen the first season. I'm so interested in it. I can't wait to see the next one. I guess that's what makes me really happy right now.""
Therapist: ""So you're excited about this television show and you have the episodes already recorded. Mm-hmm. And maybe one of the reasons you can't find the time is because the time you're using between the two parts of writing this paper?""",349.63,353.59
013_038,013,38,1,They give us about a week and a half to do it.,"Therapist: ""Okay. What would be a more comfortable pace? Like, for example, how long does it take you to write one page?""
Patient: ""About an hour, hour and a half.""
Therapist: ""All right. So around an hour to an hour and a half, you can complete one page, edited, proofread? Yeah. Okay. So it would take about... five days for you to complete the whole paper? Yes. If you did an hour and a half each day? An hour to an hour and a half each day. Okay. And how much time do you have from when the paper's assigned to when it's due?""",432.2,435.05
013_042,013,42,1,"I guess around 6 o'clock, because then I'm already done eating, I'm home from work, and I've kind of de-stressed already. 6 o'clock is a pretty good time.","Therapist: ""Okay, so around ten days?""
Therapist: ""Okay. So if you could maintain the pace of an hour to an hour and a half a day, you would be done in plenty of time?""
Therapist: ""Is there a good time to write, to start writing?""",455.17,466.29
013_051,013,51,1,"I guess around 8 o'clock, because that's when I'm starting to get ready for bed and starting to really relax. And my husband's home by that time, and we can watch it together. He loves the show, too.","Therapist: ""How long are they?""
Patient: ""They're an hour.""
Therapist: ""They're an hour. Okay. And what's a time that you could watch those or you get the maximum enjoyment out of watching them? Like no distractions?""",500.13,511.9
013_057,013,57,1,So just keep thinking about that when I feel like I'm getting off track?,"Therapist: ""It could be Monday through Friday or whatever works for you.""
Therapist: ""All right. Clearly within the 10-day window, though. All right. So five days within the 10-day window that you have to turn in. And then set that time at 6 o'clock is when you're going to start because that's a good time for you to work. Mm-hmm. All right. And when you... Try to work straight through to 7 or 7.30. I know that's a challenge, right?""
Therapist: ""And when that period of distraction might encroach, right, we know that might happen, focus on, I really want to watch that show at 8 o'clock.""",603.58,607.03
013_061,013,61,2,"Really, it is. I mean, you're right. I could watch that show with the amount of time I waste just doing other things.","Therapist: ""Yeah, that's your, in a way, that's your reward, that's your motivation, that's kind of what you're looking forward to to get through something that you don't necessarily enjoy a lot. You're going to be using what you do enjoy a lot to help push you through that. In the process, I hope that the writing becomes more enjoyable. We'll see. But whether it does or it doesn't, you still want to be able to complete it.""
Patient: ""And not have to stress right at the end.""
Therapist: ""And not waste that time in the middle. That's really eating more time than your show takes.""",646.37,654.86
013_065,013,65,1,"No, I see where you're getting at. Yeah? Yeah, absolutely.","Therapist: ""So the key here is to try to keep it structured. Like if that plan that I've laid out works for you, does that make sense for you?""
Therapist: ""Okay. Because we can modify it if it doesn't. Try that now and we can always change it up if we need to. But I think that does make sense and it gives you time to finish the paper. And I think it makes it, it divides it into manageable periods of time. Okay. But the key is, here, to start on time, 6 o'clock, and to, to intend to, and try to start the show on time, 8 o'clock. Try to keep that structure. So you have the behavior that's not necessarily too excited about, but you kind of have to do at some point. Yeah. And that show that you're really looking forward to.""
Therapist: ""You're going to pair those together.""",703.81,706.05
013_067,013,67,1,"Yeah. You know, that helped me power through and not do things unrelated by, you know, think, well, if I get this paper done, this page done, I get to watch my show later.","Therapist: ""You're going to pair those together.""
Patient: ""No, I see where you're getting at. Yeah? Yeah, absolutely.""
Therapist: ""Does this make sense to you? Do you understand kind of?""",710.18,722.89
014_004,014,4,2,I've been a little anxious about a shopping habit that I have.,"Patient: ""I'm doing good.""
Patient: ""Yeah.""
Therapist: ""What's been going on?""",20.52,26.47
014_006,014,6,2,"Well, I have to buy everything in pairs or in twos. And if I only have one thing, I won't buy it. I'll put it back. or I'll look around the store for another thing so that I have two things to buy.","Therapist: ""What's been going on?""
Patient: ""I've been a little anxious about a shopping habit that I have.""
Therapist: ""Alright. Yeah. Tell me about that.""",30.24,47.48
014_008,014,8,1,"Sometimes it can be more, as long as it's reached the minimum of two.","Therapist: ""Alright. Yeah. Tell me about that.""
Patient: ""Well, I have to buy everything in pairs or in twos. And if I only have one thing, I won't buy it. I'll put it back. or I'll look around the store for another thing so that I have two things to buy.""
Therapist: ""So when you go into a store, if you just have one thing you want to buy, one item you went there for, you'll buy a second item, or even more, or just a second?""",61.06,64.92
014_013,014,13,1,"Zero would be acceptable, yeah.","Patient: ""Right.""
Therapist: ""Or if you can't find something else, you won't buy it at all?""
Therapist: ""So zero would also be acceptable?""",76.31,79.12
014_015,014,15,2,"No, no, no, no, no. I can't do just one.","Therapist: ""So zero would also be acceptable?""
Patient: ""Zero would be acceptable, yeah.""
Therapist: ""But one?""",79.86,82.26
014_017,014,17,4,"No, it's got to be two or more.","Therapist: ""But one?""
Patient: ""No, no, no, no, no. I can't do just one.""
Therapist: ""Okay.""",84.9,87.19
014_019,014,19,2,"I can't really remember one. I'm sure there has been, but I can't really remember one.","Therapist: ""Okay.""
Patient: ""No, it's got to be two or more.""
Therapist: ""And what happens, has there ever been an occasion where you've only purchased one thing?""",95.57,100.74
014_023,014,23,4,"Oh yeah, I have to. It's very anxiety producing if I don't.","Therapist: ""So, and how long has this been going on?""
Patient: ""A number of years, a long time.""
Therapist: ""A long time, okay. So for all this period of time, you have successfully either purchased nothing or two or more items?""",118.87,122.84
014_025,014,25,4,I just feel like something bad will happen if I don't keep it to two or more.,"Therapist: ""A long time, okay. So for all this period of time, you have successfully either purchased nothing or two or more items?""
Patient: ""Oh yeah, I have to. It's very anxiety producing if I don't.""
Therapist: ""How anxiety producing?""",128.01,135.34
014_027,014,27,2,"Well, for example, like my family would be in a car accident or I would hit a deer or, you know, get fired from my job or, you know.","Therapist: ""How anxiety producing?""
Patient: ""I just feel like something bad will happen if I don't keep it to two or more.""
Therapist: ""Do you know what would happen? Like give a specific?""",142.81,152.49
014_031,014,31,2,Right. It's if I only really need one thing and then I can't just buy that one thing that I need.,"Therapist: ""Okay, so something really, really bad would happen. So this is hurtful for you. This is causing you pain.""
Therapist: ""And this would happen, this would really happen on any shopping trip where you just wanted one thing.""
Therapist: ""You'd be reminded. So if you went in wanting more than one thing, it's not a problem, right?""",174.34,184.16
014_033,014,33,2,"Yeah, because I mean, if I go grocery shopping or if I go clothes shopping or any kind of money transactional thing, you know, which I would encounter daily pretty much. It happens.","Therapist: ""You'd be reminded. So if you went in wanting more than one thing, it's not a problem, right?""
Patient: ""Right. It's if I only really need one thing and then I can't just buy that one thing that I need.""
Therapist: ""So how often does this happen where you are in a situation where you want to make a purchase of just one item and you have to change because of the anxiety?""",201.18,216.26
014_038,014,38,1,"Yeah, I guess so, yeah. Number of items or number of transactions, yeah. Because, see, if I get gas and I have the gases in my car, that's a thing.","Patient: ""Oh, then I'll buy a pack of gum.""
Therapist: ""So it has an effect at that level too?""
Therapist: ""So you're thinking of it almost like the number of transactions has to be more than one? I mean, it has to be two or zero?""",237.44,246.77
014_046,014,46,1,Exactly. Exactly. Yes.,"Therapist: ""Okay, so that's one product.""
Therapist: ""And you need another product.""
Therapist: ""So you really can't fuel your car without going inside the... No. The station, right? No. The store, okay. So it doesn't matter that there's more than one gallon going in because it's the same product.""",272.14,275.4
014_050,014,50,2,"I didn't really realize it that way, but it does. Yeah. Yeah.","Therapist: ""So I could see now this would be more of a daily thing. Yeah. Like you said, right? Yeah. Because at first I was thinking daily, that's a lot of individual shopping trips. But it applies to all transactions.""
Patient: ""Exactly.""
Therapist: ""Yeah.""",287.99,292.62
014_052,014,52,5,"Yes, it does. It builds up in me and I feel it.","Therapist: ""Yeah.""
Patient: ""I didn't really realize it that way, but it does. Yeah. Yeah.""
Therapist: ""So this is a fairly significant source of anxiety for you.""",296.7,303.17
014_054,014,54,2,"Yeah. I start with what do I need? Why am I here? I need the pack of gum. And then it's instant anxiety that, what else am I going to get? What else can I get to make it the two?","Therapist: ""So this is a fairly significant source of anxiety for you.""
Patient: ""Yes, it does. It builds up in me and I feel it.""
Therapist: ""So let's talk about that and help me to understand this better. So let's say that you went to a convenience store and you just had one thing in mind. What might be a potential item that you would... Gum. Gum, all right. So you want to go in and... You just want to buy a pack of gum. That's all you really want. That's why you stopped at the store. Right. So you go in. Do you have any thoughts? We talked in the past about automatic thoughts. These thoughts just kind of come in. Yeah. So are there any thoughts that are happening when you're walking into the store?""",345.64,357.95
014_060,014,60,2,"Yeah, so I guess the first thought is, what else do I have to get? Yeah.","Therapist: ""It has to be two.""
Patient: ""That's not the thought.""
Therapist: ""Yeah, yeah. So that thought's a little more demanding. Yeah. So it has to be.""",371.36,374.57
014_067,014,67,1,"When I'm done that, when I've left the store, I'm done the transaction, I've left the store.","Therapist: ""But it is relieved?""
Patient: ""It is relieved, yes.""
Therapist: ""And when's it completely gone?""",396.3,401.61
014_074,014,74,2,"I would guess that, I mean, we've talked about, you know, some bad experiences I had.","Therapist: ""Okay. So if you could relieve that anxiety, that would be one of your goals.""
Patient: ""That would be fantastic.""
Therapist: ""That would be fantastic. Yeah. All right. So let's think about it this way. Do you know the reason that you do this? Do you have any guesses?""",447.91,454.28
014_076,014,76,2,"Yeah, they were difficult. So I wonder if that's not somehow linked to this behavior somehow, you know, possibly.","Therapist: ""That would be fantastic. Yeah. All right. So let's think about it this way. Do you know the reason that you do this? Do you have any guesses?""
Patient: ""I would guess that, I mean, we've talked about, you know, some bad experiences I had.""
Therapist: ""They sound awful.""",455.44,467.96
014_078,014,78,2,"Yes, yes. Like the car accident or the, yes, safety. Definitely my personal safety or my family's safety.","Therapist: ""They sound awful.""
Patient: ""Yeah, they were difficult. So I wonder if that's not somehow linked to this behavior somehow, you know, possibly.""
Therapist: ""All right. You've been through some really tough times, to put it mildly. And what you're afraid of, if you only buy the one item, is something safety related happening.""",487.32,493.73
014_084,014,84,2,"Well, now that you pointed out the safety-security issue, I didn't really realize that, but it is. Maybe just that I'm not okay, I'm not safe.","Therapist: ""So safety and security, they're at risk for you.""
Therapist: ""When you don't follow this... My role. The rule.""
Therapist: ""Yeah. So, if we think about it in terms of the cognitive model, we talk about the core beliefs and the intermediate beliefs, which are the attitudes and assumptions and expectations. So the core belief here, do you have any thoughts on what it might be?""",527.04,540.42
014_086,014,86,4,"Vulnerable, yeah. I'm vulnerable, and I'm exposed.","Therapist: ""Yeah. So, if we think about it in terms of the cognitive model, we talk about the core beliefs and the intermediate beliefs, which are the attitudes and assumptions and expectations. So the core belief here, do you have any thoughts on what it might be?""
Patient: ""Well, now that you pointed out the safety-security issue, I didn't really realize that, but it is. Maybe just that I'm not okay, I'm not safe.""
Therapist: ""I'm not okay, I'm not safe, I am vulnerable.""",546.11,550.29
014_093,014,93,2,When the situation and the...,"Therapist: ""So with that core belief, we move down to kind of like the assumptions, in this case the rule. So the rule is, I can stay safe if I transact involving only two or more... Products. Products. Yeah. Alright, so that's your rule.""
Patient: ""That's my rule.""
Therapist: ""And then when a situation presents itself, which would be an impending transaction or multiple, right? That's the situation. We talked about how the situation blends together with that, in this case, rule, that intermediate belief. So when they come together, what's that automatic thought?""",609.99,612.03
014_095,014,95,2,In twos. In twos. What else am I going to get? So that's your automatic thought. That's my automatic thought.,"Therapist: ""And then when a situation presents itself, which would be an impending transaction or multiple, right? That's the situation. We talked about how the situation blends together with that, in this case, rule, that intermediate belief. So when they come together, what's that automatic thought?""
Patient: ""When the situation and the...""
Therapist: ""The potential transaction is approaching you and you have the intermediate belief of, I need to buy everything.""",618.59,624.08
014_101,014,101,2,That follows that purchase of two or?,"Therapist: ""You buy the second item.""
Patient: ""Yeah.""
Therapist: ""And the feeling, what's the feeling that follows that?""",636.47,639.11
014_108,014,108,1,"Very much. It fits it very well I think, yeah.","Patient: ""The purchase.""
Therapist: ""Yeah. Relief. Relief. All right.""
Therapist: ""So can you see how the mechanism of what's happening to you could be explained, just one explanation, through the cognitive model?""",656.91,662.93
014_110,014,110,2,"No. I mean, there's no... I recognize, you know, recognize through our work and stuff that it's not... it doesn't make sense. It's not a useful... a useful thought, maybe.","Therapist: ""So can you see how the mechanism of what's happening to you could be explained, just one explanation, through the cognitive model?""
Patient: ""Very much. It fits it very well I think, yeah.""
Therapist: ""Right. So let's talk about the rule of two. Now we talked before when we were talking about cognitive therapy about useful and less than useful thoughts, right? Functional and less functional or dysfunctional thoughts. Do you think that sitting here now, not so much necessarily in the store, because I know that's probably a different thought process, but talking with me now, do you see a causal connection between purchasing two items and a safety or security breach? Something bad happened?""",711.79,728.01
014_112,014,112,1,True. That's very true. Yeah.,"Therapist: ""Right. So let's talk about the rule of two. Now we talked before when we were talking about cognitive therapy about useful and less than useful thoughts, right? Functional and less functional or dysfunctional thoughts. Do you think that sitting here now, not so much necessarily in the store, because I know that's probably a different thought process, but talking with me now, do you see a causal connection between purchasing two items and a safety or security breach? Something bad happened?""
Patient: ""No. I mean, there's no... I recognize, you know, recognize through our work and stuff that it's not... it doesn't make sense. It's not a useful... a useful thought, maybe.""
Therapist: ""It's not a useful, in this case, thought, maybe not a useful intermediate belief. Yeah, yeah. So you recognize that, you appreciate that there's not a link between the purchasing behavior and either direction though, right? Meaning, so you realize that if you buy two, that doesn't necessarily keep you safe either. So you can't introduce safety or the process or risk of being unsafe. You can't introduce risk or safety through your transacting behavior.""",773.42,776.19
014_114,014,114,1,"Yeah, it does. It really does. I can't. It doesn't make... What you're saying makes sense, but it doesn't make sense to introduce safety or either side of the coin.","Therapist: ""It's not a useful, in this case, thought, maybe not a useful intermediate belief. Yeah, yeah. So you recognize that, you appreciate that there's not a link between the purchasing behavior and either direction though, right? Meaning, so you realize that if you buy two, that doesn't necessarily keep you safe either. So you can't introduce safety or the process or risk of being unsafe. You can't introduce risk or safety through your transacting behavior.""
Patient: ""True. That's very true. Yeah.""
Therapist: ""Does that make sense?""",777.75,788.2
014_116,014,116,4,"Yeah, I don't see a link, but I know what I feel. And what I feel is that impending doom, if you will.","Therapist: ""Does that make sense?""
Patient: ""Yeah, it does. It really does. I can't. It doesn't make... What you're saying makes sense, but it doesn't make sense to introduce safety or either side of the coin.""
Therapist: ""Safety or risk. Or risk. They're not influenced by your behavior. Yeah. But that's not what your mind is telling you. That's not what your thoughts are telling you. That's logical, and you can sit here with me, and it's maybe not easy to say, but you can say, yeah, I don't see a link.""",809.96,815.92
014_118,014,118,2,You want to... I need it in your scenario.,"Therapist: ""Safety or risk. Or risk. They're not influenced by your behavior. Yeah. But that's not what your mind is telling you. That's not what your thoughts are telling you. That's logical, and you can sit here with me, and it's maybe not easy to say, but you can say, yeah, I don't see a link.""
Patient: ""Yeah, I don't see a link, but I know what I feel. And what I feel is that impending doom, if you will.""
Therapist: ""So let's talk about that moment. So in this moment, maybe a little anxious now, But you can kind of see how you can't protect yourself or cause harm to yourself or anyone else by buying two or failing to buy two. Right. In the store, or wherever you make the transaction, different story. So you have, let's go a different direction. I talked about how you walk into the store and you think, what else can I get? That was the thought, right? And you end up getting something else. Yes. then kind of goes away. And it'll come up the next time that happens. But it's away, it's gone for that moment. So I want you to kind of stay with me as I go through another scenario. And maybe you've figured out what I'm going to do here. Let's say that you only have, maybe you forgot your credit card or cash or whatever, and you only have enough money for the gum. And you want the gum. Let's just for a moment say it's really important to you. So it's not something you want to turn into a zero.""",892.07,896.08
014_120,014,120,4,"What I would normally do or what I... What do you think would happen? I would panic. I mean, not panic, like, you know, break down or something, but I mean, it would be very, very stressful. If I absolutely had to get that item, I would probably try to scrape change out of my car, but I know we're not going there.","Therapist: ""So let's talk about that moment. So in this moment, maybe a little anxious now, But you can kind of see how you can't protect yourself or cause harm to yourself or anyone else by buying two or failing to buy two. Right. In the store, or wherever you make the transaction, different story. So you have, let's go a different direction. I talked about how you walk into the store and you think, what else can I get? That was the thought, right? And you end up getting something else. Yes. then kind of goes away. And it'll come up the next time that happens. But it's away, it's gone for that moment. So I want you to kind of stay with me as I go through another scenario. And maybe you've figured out what I'm going to do here. Let's say that you only have, maybe you forgot your credit card or cash or whatever, and you only have enough money for the gum. And you want the gum. Let's just for a moment say it's really important to you. So it's not something you want to turn into a zero.""
Patient: ""You want to... I need it in your scenario.""
Therapist: ""So maybe gum isn't the ideal example, but you see my... So now you go into the store. You realize you only have enough resources to make the one transaction. It's... And you really want it, so zero is not an option. So now walk me through the thoughts and the feelings.""",921.87,953.81
014_122,014,122,4,"Stay with us there. But it would be very, very difficult for me.","Therapist: ""So maybe gum isn't the ideal example, but you see my... So now you go into the store. You realize you only have enough resources to make the one transaction. It's... And you really want it, so zero is not an option. So now walk me through the thoughts and the feelings.""
Patient: ""What I would normally do or what I... What do you think would happen? I would panic. I mean, not panic, like, you know, break down or something, but I mean, it would be very, very stressful. If I absolutely had to get that item, I would probably try to scrape change out of my car, but I know we're not going there.""
Therapist: ""Stay with us. Okay, I know.""",955.11,958.85
014_126,014,126,2,I could do it. I could do it. I could get through it.,"Therapist: ""Could you do it?""
Patient: ""I'm physically capable of doing it.""
Therapist: ""Okay. And that is one level of being able. But how about in terms of your thinking and your feelings?""",972.16,974.9
014_128,014,128,2,"It would fade off, I think. I mean, it would have to. I would imagine. So, it would fade. I think it would take a longer period of time to fade than if I had just gotten, even announcing here, but even if I had just gotten another item, okay, the world is going to be safe for another five minutes, we're good.","Therapist: ""Okay. And that is one level of being able. But how about in terms of your thinking and your feelings?""
Patient: ""I could do it. I could do it. I could get through it.""
Therapist: ""Somehow. And what would happen? How much anxiety would you experience and would the anxiety fade off?""",982.37,1001.7
014_130,014,130,2,Very anxious.,"Therapist: ""Somehow. And what would happen? How much anxiety would you experience and would the anxiety fade off?""
Patient: ""It would fade off, I think. I mean, it would have to. I would imagine. So, it would fade. I think it would take a longer period of time to fade than if I had just gotten, even announcing here, but even if I had just gotten another item, okay, the world is going to be safe for another five minutes, we're good.""
Therapist: ""Tell me what you're feeling right now. Very anxious.""",1004.83,1007.21
014_132,014,132,2,Yeah.,"Therapist: ""Tell me what you're feeling right now. Very anxious.""
Patient: ""Very anxious.""
Therapist: ""Yeah. Are you worried, is it the kind of anxiety where you're worried that something catastrophic is going to happen? Mm-hmm. Okay. So even talking about a transaction of one can lead to... Anxiety. Anxiety connected to this safety and security thing.""",1027.06,1029.26
014_134,014,134,2,Yeah. Yeah. Huh. Yeah.,"Therapist: ""Yeah. Are you worried, is it the kind of anxiety where you're worried that something catastrophic is going to happen? Mm-hmm. Okay. So even talking about a transaction of one can lead to... Anxiety. Anxiety connected to this safety and security thing.""
Patient: ""Yeah.""
Therapist: ""Yeah. So you can... trigger that without a transaction even pending.""",1036.98,1041.3
014_141,014,141,2,Your scenario of having to get only one item. Or only having the resources for one item.,"Therapist: ""Yeah, it's hurting.""
Patient: ""It doesn't feel good.""
Therapist: ""What do you feel is going to happen? What's the anxiety about?""",1057.02,1063.4
014_145,014,145,4,I know. Yeah. It's terrifying.,"Therapist: ""Okay, so it's not a safety and security. It's a concern about following through and buying one item.""
Patient: ""On the rule. The rule is two.""
Therapist: ""Yeah. Yeah. And I'm talking about breaking the rule.""",1076.1,1078.38
014_149,014,149,2,"Yes, so I'll get something else.","Therapist: ""It's scary for you. Mm-hmm. So you're anxious about that and you're also anxious about the consequence of that? Yes. You are? Yes. And that's the safety and security? Yeah. All right. All right. So, the anxiety you're experiencing right now in this moment with me, I want you to be mindful of that. Keep that in your awareness. And let me know if that changes. Just interrupt me if you need to. It's not... Okay. All right. So, it might get worse. It might get better. So, is there something on your mind that you need to buy within the next couple of days?""
Patient: ""Yes. Coffee.""
Therapist: ""Coffee. And that's a transaction of one.""",1126.76,1128.84
014_157,014,157,2,"I would have a lot more anxiety, but I would really have to talk myself through that.","Therapist: ""Yeah. Very good.""
Patient: ""This scenario too.""
Therapist: ""Yeah. And to buy one, to buy one cup of coffee, And then, I don't know where you buy the coffee, but leaf, yeah. Wherever it is, leaf. So, what are the possible things that could happen, knowing that logically you can't connect it to a safety thing? And you might be anxious about that, and that's real, that anxiety is real. But knowing that the event isn't prevented or caused by the transacting behavior. Let's go through what happens. So you buy the coffee. you're really anxious, right? You're up to it, you're anxious, you know, going by driving there even, right? Yeah. So you're driving there, you're anxious, maybe you have doubts, maybe you have some thoughts of, I'm not going to do this, right? But let's say you fall through, buy a cup of coffee, and you leave. Nothing, it doesn't change the safety and security aspect. What is different about that than... if you bought two items?""",1211.31,1219.38
014_159,014,159,1,I believe it would. The anxiety? I believe it would.,"Therapist: ""Yeah. And to buy one, to buy one cup of coffee, And then, I don't know where you buy the coffee, but leaf, yeah. Wherever it is, leaf. So, what are the possible things that could happen, knowing that logically you can't connect it to a safety thing? And you might be anxious about that, and that's real, that anxiety is real. But knowing that the event isn't prevented or caused by the transacting behavior. Let's go through what happens. So you buy the coffee. you're really anxious, right? You're up to it, you're anxious, you know, going by driving there even, right? Yeah. So you're driving there, you're anxious, maybe you have doubts, maybe you have some thoughts of, I'm not going to do this, right? But let's say you fall through, buy a cup of coffee, and you leave. Nothing, it doesn't change the safety and security aspect. What is different about that than... if you bought two items?""
Patient: ""I would have a lot more anxiety, but I would really have to talk myself through that.""
Therapist: ""Would it go away?""",1223.33,1226.51
014_167,014,167,2,"It could be. It would get old, I think. The anxiety would get old. The anxiety would get old.","Therapist: ""So what would happen if you did it again?""
Patient: ""I would hope that it would be less anxiety.""
Therapist: ""Well, if you did it a hundred times.""",1250.7,1256.83
014_175,014,175,1,"I wouldn't have to walk through the cold to the store. Right. Or to the, you know, the door of the, yeah.","Therapist: ""So what scenario of purchasing, and I know I asked for the coffee example, I mean I asked for one thing you're going to buy and you mentioned the coffee. What scenario could you see yourself being most likely to fall through at this? I don't know if the coffee is the optimal situation for the behavior experiment, maybe. I guess, would there be another item that would be easier to actually fall through? Like for example, the gasoline, because you'd be at your car. You'd buy the gasoline and you'd leave?""
Patient: ""Yeah, that would be easier.""
Therapist: ""You wouldn't be tempted by the other...""",1321.3,1327.32
014_179,014,179,4,"Because the other thing about the gas is that even though it's physically with me, the product is in my gas tank, I'm not holding it. I don't know. I think that that could make it easier to follow through, yeah.","Therapist: ""Would that be, you think that would be, you know, might be more or less anxiety provoking, but do you think that would be easier to actually be successful?""
Patient: ""I think that would be much easier.""
Therapist: ""Okay. Yeah.""",1337.13,1353.2
014_183,014,183,1,Okay. I feel more confident about that.,"Therapist: ""So we would consider that kind of a step in a direction that would result in fewer symptoms.""
Patient: ""Yeah, that would be wonderful.""
Therapist: ""And maybe another step in the future, if we get there, see how it goes with this, but it would be to go into the store and buy one. But let's not do that. Okay. Let's stick with the gasoline.""",1375.53,1377.88
014_185,014,185,2,"Yeah. We'll see when we actually get there, but yes. I feel like I could actually try that more so than the coffee.","Therapist: ""And maybe another step in the future, if we get there, see how it goes with this, but it would be to go into the store and buy one. But let's not do that. Okay. Let's stick with the gasoline.""
Patient: ""Okay. I feel more confident about that.""
Therapist: ""You feel like you could succeed with that experiment?""",1382.47,1389.43
014_187,014,187,4,"Yes. And they have the pay at the pump, so that would be...","Therapist: ""You feel like you could succeed with that experiment?""
Patient: ""Yeah. We'll see when we actually get there, but yes. I feel like I could actually try that more so than the coffee.""
Therapist: ""Are you afraid with the coffee that you might just end up buying two things? Okay. So let's go with the fuel in your car. So the next time that your car needs fuel, right? go in, buy the fuel, drive away.""",1410.22,1414.17
014_189,014,189,1,"I don't even have to go into the store, so that would be great, yeah.","Therapist: ""Are you afraid with the coffee that you might just end up buying two things? Okay. So let's go with the fuel in your car. So the next time that your car needs fuel, right? go in, buy the fuel, drive away.""
Patient: ""Yes. And they have the pay at the pump, so that would be...""
Therapist: ""But you don't even have to go...""",1415.43,1419.43
014_191,014,191,1,I feel better that I don't have to just buy one cup of coffee.,"Therapist: ""But you don't even have to go...""
Patient: ""I don't even have to go into the store, so that would be great, yeah.""
Therapist: ""So how's your anxiety now?""",1421.7,1424.58
014_193,014,193,2,"That was a stressor, but I feel it's mild, but okay.","Therapist: ""So how's your anxiety now?""
Patient: ""I feel better that I don't have to just buy one cup of coffee.""
Therapist: ""Okay, so that was a stressor for you.""",1426.14,1432.81
014_196,014,196,1,"Yeah. And because I think like the insight that you gave me on, I hadn't connected the safety security, I hadn't connected all the dots, so that was very helpful.","Patient: ""That was a stressor, but I feel it's mild, but okay.""
Therapist: ""Better than it was a few months ago?""
Therapist: ""But mostly because the experiment that we're talking about is a little easier.""",1441.03,1450.14
014_198,014,198,1,"Yeah. Does that make sense? Yeah, absolutely.","Therapist: ""But mostly because the experiment that we're talking about is a little easier.""
Patient: ""Yeah. And because I think like the insight that you gave me on, I hadn't connected the safety security, I hadn't connected all the dots, so that was very helpful.""
Therapist: ""Right, so one of the, and we talked about before with the automatic thoughts, like adaptive responses, right? So as you're trying to kind of push through this experience of just feeling the car, you're going to have those thoughts still come up. And the adaptive response could be something like, well, I'd like you to design it or work with me in designing it. But it could be something like, I know this won't actually have a consequence in the real world. Yeah. I realize this is just how, you know, responding internally. It doesn't take away the anxiety, necessarily. It might. But it will help you maybe get through that process.""",1490.53,1494.51
014_202,014,202,2,"To kind of pair the two. Yeah, I got you.","Therapist: ""So there's a few things I'm asking you to do, right? One is to just buy gasoline. Mm-hmm. When you need it. Yeah. And to only buy gasoline.""
Patient: ""Mm-hmm.""
Therapist: ""And at the same time, when those thoughts come up, to respond to them with the adaptive responses.""",1511.41,1513.65
014_211,014,211,2,"I do. I do. It's been a long time, but the behaviors and the thought processes have been in place for a long time, so I think it'll be a challenge, but I think, you know, it's time.","Patient: ""Yes, I like that a lot.""
Therapist: ""So we're kind of attacking the anxiety from a lot of different angles here. And my hope is that the more we can replicate the behavior of just buying one item, the more your anxiety will decrease. We have other things we'll try too. We'll work on it after responding. We'll look at other angles, but I want to make that something we try early on.""
Therapist: ""So do you believe that you could succeed with this?""",1601.85,1616.24
014_219,014,219,1,"I will. I will need to do that, yeah.","Therapist: ""So I don't know if you know the status of your gas tank right now, your fuel level. Do you foresee needing to get gas between now and next week?""
Patient: ""Oh yeah.""
Therapist: ""You do?""",1711.71,1714.74
014_221,014,221,3,Kind of like the same as we were talking about with the thoughts and all.,"Therapist: ""You do?""
Patient: ""I will. I will need to do that, yeah.""
Therapist: ""So if you could try that out, and if you could record kind of in the moment, like after it's over, the experience in terms of your feelings at different stages, that would be helpful. as you pulled up to the gas station.""",1729.5,1732.86
015_003,015,3,3,"Things, you know, I've been really sort of preoccupied and anxious a lot this week. My daughter got sick so I had to take three days off of work to take care of her and I'm starting to worry. She's been sick a lot since I've gone back to work and she's in daycare. I've had to take a lot of time off work and I'm getting close to going over my allotted amount of days. So I'm finding myself being very anxious about that and then feeling guilty because when I'm trying to take care of her, I'm always worrying about work.","Therapist: ""Hi Samantha, how are you doing today?""
Patient: ""Good, how are you?""
Therapist: ""I'm doing alright. How have things been since last week?""",22.24,54.18
015_007,015,7,5,"The last time I had to take off work? It was just this week. She woke up one morning with a really high fever, so I had to call out that day. And then she still had a fever the next day, and then I had to take a third day because she has to be fever-free before she can go back to daycare. So the first day, I was okay with that. But then, like, the second, and then when I started realizing that I was going to have to take a third day, then I really started to get kind of panicky and worried about it.","Therapist: ""Okay, so it sounds like a couple things may be going on. The child's been sick, she's been taking off days, so you're a little worried about your relationship with your employer, right? At the same time, you want to make sure you're taking good care of your child so you're having trouble reconciling those two.""
Patient: ""Yeah.""
Therapist: ""All right. What was the last time it happened? Can you describe what happened?""",81.29,109.35
015_009,015,9,2,"Well, because she's been sort of sick a lot lately, I was a little bit worried. And I was sort of, you know, I have this number 10 because I only have 10 days for the whole year. So I had this number in my head and I just thought, okay, well, there's one more day I got to take away from that 10 that I have. But I was able to sort of think about, I was a little worried about any work that I would miss. you know, keeping up with my caseload and stuff at work. So, um, but I was able to kind of figure out that I would be okay for a day and I can kind of make up for that when I get, get back.","Therapist: ""All right. What was the last time it happened? Can you describe what happened?""
Patient: ""The last time I had to take off work? It was just this week. She woke up one morning with a really high fever, so I had to call out that day. And then she still had a fever the next day, and then I had to take a third day because she has to be fever-free before she can go back to daycare. So the first day, I was okay with that. But then, like, the second, and then when I started realizing that I was going to have to take a third day, then I really started to get kind of panicky and worried about it.""
Therapist: ""All right, so let me see. Let's go through each day, all right? So the first day when you discovered that she was sick, right? What were you thinking then when you had to call out of work?""",123.18,158.54
015_013,015,13,4,"Then I got a little bit more worried. Um, And then I did start to also add the worry of I was going to start to get behind at work. Not only was I missing more time, but I was also going to be behind on my work. So then I started thinking, when I go back, it's going to be a mad scramble to kind of catch up and keep up with everything. And so then it became worrying about my workload and worrying about taking more time.","Therapist: ""Okay. So your thinking was this isn't ideal, but I can, I can live with it.""
Therapist: ""It's one, it's one day.""
Therapist: ""How about on, on day two when you realized that you're going to have to take a second day?""",171.5,198.3
015_015,015,15,5,"I was, then it was just more amplified, you know, amplified worry. And it was a lot harder for me to let it go. I just kept thinking, I kept going back to it. And then I started feeling guilty because I was so preoccupied, worried about that. And I was trying to answer emails and do some stuff and send out some emails to people that I work with to try to help me out with things at work since I wasn't there. And then I felt guilty because I wasn't really caring for my child as best as I felt I should have been. You know, I started feeling kind of like a bad mom.","Therapist: ""How about on, on day two when you realized that you're going to have to take a second day?""
Patient: ""Then I got a little bit more worried. Um, And then I did start to also add the worry of I was going to start to get behind at work. Not only was I missing more time, but I was also going to be behind on my work. So then I started thinking, when I go back, it's going to be a mad scramble to kind of catch up and keep up with everything. And so then it became worrying about my workload and worrying about taking more time.""
Therapist: ""OK. So a little more stressful version of what happened on day one. And then how about when you discovered that you had to take a third day off?""",210.75,244.64
015_018,015,18,4,"Well, I checked in. um with the main office and you know I just said I'm really you know I'm starting to worry I'm getting I know I'm had to take a lot of time but you know I've done the best I can to try to make other arrangements but my you know just starting back in starting in daycare she's just been sick a lot and I can't control it I'm doing the best I can you know I asked them if there was anything I needed to do as far as providing doctor's notes and stuff um and they said no that you know They don't need a doctor's note since it was my daughter that was sick. They said there's nothing, nothing that I really can do and just try to not have it happen much more if I can. Just do what I can to not miss more.","Patient: ""I was, then it was just more amplified, you know, amplified worry. And it was a lot harder for me to let it go. I just kept thinking, I kept going back to it. And then I started feeling guilty because I was so preoccupied, worried about that. And I was trying to answer emails and do some stuff and send out some emails to people that I work with to try to help me out with things at work since I wasn't there. And then I felt guilty because I wasn't really caring for my child as best as I felt I should have been. You know, I started feeling kind of like a bad mom.""
Therapist: ""So guilty and a bad mom. And that was basically on the third day. That was the worst of it. Yes. Now, did this go up against the weekend? It was the third day of Friday? Mm-hmm. All right. So then you kind of knew that by Monday things would be able to return to work.""
Therapist: ""So tell me what happened when you returned to work on Monday.""",262.52,306.64
015_020,015,20,4,"Yeah, but, yeah.","Therapist: ""So tell me what happened when you returned to work on Monday.""
Patient: ""Well, I checked in. um with the main office and you know I just said I'm really you know I'm starting to worry I'm getting I know I'm had to take a lot of time but you know I've done the best I can to try to make other arrangements but my you know just starting back in starting in daycare she's just been sick a lot and I can't control it I'm doing the best I can you know I asked them if there was anything I needed to do as far as providing doctor's notes and stuff um and they said no that you know They don't need a doctor's note since it was my daughter that was sick. They said there's nothing, nothing that I really can do and just try to not have it happen much more if I can. Just do what I can to not miss more.""
Therapist: ""So they said that to you?""",308.43,310.45
015_022,015,22,2,"They kind of just said, you know, do what you can to not have it happen, but if it you know, if it has to happen, you know, what can I do about it? That's kind of what they were saying.","Therapist: ""So they said that to you?""
Patient: ""Yeah, but, yeah.""
Therapist: ""And how did they frame that?""",314.11,327.56
015_024,015,24,2,"I didn't feel like they were that understanding, but I also didn't feel like they were going to take any punitive action against me right then and there or anything.","Therapist: ""And how did they frame that?""
Patient: ""They kind of just said, you know, do what you can to not have it happen, but if it you know, if it has to happen, you know, what can I do about it? That's kind of what they were saying.""
Therapist: ""So they were understanding?""",331.17,341.82
015_026,015,26,2,"Yeah, I did. And I also anticipated that they would maybe have more of a procedure for how to handle it, and they didn't have a procedure, which also made me feel a little worried. I can't imagine I'm the first mom that has had to deal with this, and they kind of talked like it's never happened before. So I kind of felt anxious because I thought, am I really the first mom that's had to take a lot of time off because they're child sick? protocol or like they had dealt with this before.","Therapist: ""So they were understanding?""
Patient: ""I didn't feel like they were that understanding, but I also didn't feel like they were going to take any punitive action against me right then and there or anything.""
Therapist: ""Did you anticipate a worse reaction than you experienced?""",351.44,384.32
015_028,015,28,2,"Yeah, or they just didn't have a plan for what to do about it.","Therapist: ""Did you anticipate a worse reaction than you experienced?""
Patient: ""Yeah, I did. And I also anticipated that they would maybe have more of a procedure for how to handle it, and they didn't have a procedure, which also made me feel a little worried. I can't imagine I'm the first mom that has had to deal with this, and they kind of talked like it's never happened before. So I kind of felt anxious because I thought, am I really the first mom that's had to take a lot of time off because they're child sick? protocol or like they had dealt with this before.""
Therapist: ""So sort of like it took them by surprise?""",389.73,394.35
015_034,015,34,2,"Oh, it's been very busy because I'm trying to catch up. and get everything handled. But that's the way it always is, so. Nobody has said anything to me or anything about the absences.","Therapist: ""And when was this again? How long ago?""
Patient: ""Just this past week. Just this week.""
Therapist: ""So how has this week been at your work?""",408.53,422.93
015_038,015,38,1,"Somebody who takes care of their child and puts them, makes them a priority, like their first priority. And um, you know, does the things that they need to do to make sure their child is taken care of.","Therapist: ""Other than that first day?""
Patient: ""Other than, yeah.""
Therapist: ""And there have been no more absences? Mm-mm. Okay. Earlier you mentioned being a good mom. What does a good mom look like?""",438.37,453.1
015_040,015,40,2,"Yeah, I felt like I wasn't being a good mom because I was preoccupied and making work a bit of a bigger priority than taking care of my kid.","Therapist: ""And there have been no more absences? Mm-mm. Okay. Earlier you mentioned being a good mom. What does a good mom look like?""
Patient: ""Somebody who takes care of their child and puts them, makes them a priority, like their first priority. And um, you know, does the things that they need to do to make sure their child is taken care of.""
Therapist: ""And you're a little worried through this, this last experience you were talking about, that you didn't rise to the level of good mom.""",463.13,477.06
015_044,015,44,1,"Well, somebody that, you know, takes care of all of their workload and handles all of the tasks that they have each day and someone that's consistent and reliable and, you know, puts effort into what they're doing. and gets their job done, really, you know, reliably.","Therapist: ""Okay, so Good Mom's more about, more than just rather, your behavior, what you're doing, it's about what you're also thinking. So you took care of your child.""
Therapist: ""But your mind, your thoughts were somewhere else some of the time. And that's where you feel like you've wandered out of the good mom area. Mm-hmm. Okay. How about on the other side? How about a good employee? Did you mention that? You want to be a good employee?""
Therapist: ""Yeah. What's that look like?""",512.91,534.69
015_047,015,47,2,"Well, I missed a lot for maternity leave.","Patient: ""Well, somebody that, you know, takes care of all of their workload and handles all of the tasks that they have each day and someone that's consistent and reliable and, you know, puts effort into what they're doing. and gets their job done, really, you know, reliably.""
Therapist: ""And that's where you feel like with the last eight work days, you missed three? Mm-hmm.""
Therapist: ""How about in the last year? How many days have you missed?""",549.13,551.66
015_049,015,49,4,"I've missed... Since the school year started, if you include the three, I've missed nine days. But some of those were half days. They add up to nine days.","Therapist: ""How about in the last year? How many days have you missed?""
Patient: ""Well, I missed a lot for maternity leave.""
Therapist: ""Well, certainly understandable, but excluding that.""",555.0,565.89
015_055,015,55,2,It's only January and I'm already at nine.,"Therapist: ""And you're allowed...""
Patient: ""Ten per school year.""
Therapist: ""Per school year.""",571.93,574.06
015_057,015,57,2,"I don't know. I mean, I think that they would dock my pay for those. If I was there a day and I didn't have any more sick days left, they would just dock my pay for that day. But outside of that, I don't know what else would happen.","Therapist: ""Per school year.""
Patient: ""It's only January and I'm already at nine.""
Therapist: ""I can see where that would cause worry. What happens if you go over the...""",581.08,593.32
015_059,015,59,2,"Yeah, I guess I could contact the HR department.","Therapist: ""I can see where that would cause worry. What happens if you go over the...""
Patient: ""I don't know. I mean, I think that they would dock my pay for those. If I was there a day and I didn't have any more sick days left, they would just dock my pay for that day. But outside of that, I don't know what else would happen.""
Therapist: ""Is there anybody that you work with that you could ask that question to? Like an HR department?""",601.88,604.35
015_064,015,64,2,A little bit sometimes when I start feeling like I'm a bad mom.,"Therapist: ""So this is, this whole thing though, the missing days, cause you anxiety, frustration?""
Patient: ""Yeah, a little bit.""
Therapist: ""How about any type of feeling down at all?""",633.54,636.58
015_066,015,66,2,Probably sort of the guilt and the feelings of not being able to be the best mom.,"Therapist: ""How about any type of feeling down at all?""
Patient: ""A little bit sometimes when I start feeling like I'm a bad mom.""
Therapist: ""Okay, so as far as your child's concerned, your relationship with your child, you have some anxiety, relationship at work, some anxiety, but the sadness mostly surrounds how you feel you're treating your child. Of all the emotions, frustration, anxiety, what I'll refer to as depression, let's just say sadness, what's bothering you the most? What emotional response? is bothering you most?""",670.35,677.23
015_068,015,68,4,"Probably like, I don't know, an eight?","Therapist: ""Okay, so as far as your child's concerned, your relationship with your child, you have some anxiety, relationship at work, some anxiety, but the sadness mostly surrounds how you feel you're treating your child. Of all the emotions, frustration, anxiety, what I'll refer to as depression, let's just say sadness, what's bothering you the most? What emotional response? is bothering you most?""
Patient: ""Probably sort of the guilt and the feelings of not being able to be the best mom.""
Therapist: ""How would you rate yourself right now as a mother if, say, ten was the best mother you could imagine, right? And one was the absolute worst?""",691.59,697.08
015_071,015,71,2,"I guess like halfway, like five.","Patient: ""Probably like, I don't know, an eight?""
Therapist: ""An eight? Okay. That's pretty good, right?""
Therapist: ""What would be the cutoff to where, what's the cutoff score in that little scale I just gave you for good mother and not good mother?""",711.48,714.2
015_073,015,73,4,Yeah. I don't feel like it's good enough for me.,"Therapist: ""What would be the cutoff to where, what's the cutoff score in that little scale I just gave you for good mother and not good mother?""
Patient: ""I guess like halfway, like five.""
Therapist: ""So five is good enough?""",717.47,721.31
015_087,015,87,4,"Yes. What happens if you... Well, as good a mother as I want to be.","Patient: ""Yeah.""
Patient: ""Yeah.""
Therapist: ""Not sure. Okay. So you're close to the border. You're close to the border in your value system. of being not a good mother?""",764.34,769.14
015_089,015,89,1,"Yeah, I want to be like an 8 or higher.","Therapist: ""Not sure. Okay. So you're close to the border. You're close to the border in your value system. of being not a good mother?""
Patient: ""Yes. What happens if you... Well, as good a mother as I want to be.""
Therapist: ""Okay. And how good do you want to be?""",773.45,775.77
015_091,015,91,2,"Well, yeah. Doesn't everybody want to be the best at what they do?","Therapist: ""Okay. And how good do you want to be?""
Patient: ""Yeah, I want to be like an 8 or higher.""
Therapist: ""8 or higher. Well, you are an 8, you said. Yeah. Okay. So you want to be a 10, sounds like.""",780.23,784.32
015_093,015,93,2,"No. There's some leeway, I guess. You have to allow for that.","Therapist: ""8 or higher. Well, you are an 8, you said. Yeah. Okay. So you want to be a 10, sounds like.""
Patient: ""Well, yeah. Doesn't everybody want to be the best at what they do?""
Therapist: ""I think people are driven to... to do their best, but is it crucial to be perfect? Is it crucial to be a 10?""",795.74,800.55
015_095,015,95,2,Mm-hmm.,"Therapist: ""I think people are driven to... to do their best, but is it crucial to be perfect? Is it crucial to be a 10?""
Patient: ""No. There's some leeway, I guess. You have to allow for that.""
Therapist: ""Remember before, in other sessions, for other situations you've brought in here, we talked about dysfunctional thinking, irrational thinking.""",811.08,814.9
015_097,015,97,2,"Uh, in some ways it's useful because it keeps me, um,","Therapist: ""Remember before, in other sessions, for other situations you've brought in here, we talked about dysfunctional thinking, irrational thinking.""
Patient: ""Mm-hmm.""
Therapist: ""How does, when you reflect on that, like the usefulness of, of these thoughts, the, you know, that other mothers can be a five and be, and that's, that's good, right? You, you need to be an eight or higher, eight, nine, or ten. Does it seem useful, like a useful way of thinking?""",836.61,842.38
015_098,015,98,1,"It keeps me on track, if that makes sense. It keeps me pushing to keep doing the best I can do. It keeps you driven. Driven. Motivated.","Patient: ""Mm-hmm.""
Therapist: ""How does, when you reflect on that, like the usefulness of, of these thoughts, the, you know, that other mothers can be a five and be, and that's, that's good, right? You, you need to be an eight or higher, eight, nine, or ten. Does it seem useful, like a useful way of thinking?""
Patient: ""Uh, in some ways it's useful because it keeps me, um,""",847.41,856.12
015_101,015,101,2,"Well, yeah, I guess it does in the sense that if I become too worried about it, then I'm wasting energy on worry instead of being able to put that energy into being a good mom.","Patient: ""It keeps me on track, if that makes sense. It keeps me pushing to keep doing the best I can do. It keeps you driven. Driven. Motivated.""
Patient: ""Yeah, motivated.""
Therapist: ""So it does have a useful side. Does it have an unuseful side? A less than useful side?""",865.83,878.73
015_106,015,106,2,Yeah.,"Patient: ""Probably not.""
Therapist: ""Probably not. So you're suffering with it.""
Therapist: ""It might make you a little more vigilant, but mostly it's just causing you to suffer.""",902.79,905.27
015_111,015,111,2,"Yeah. No, it was really the night before. Well, you know, I went as far as to think, am I going to get fired? You know, I had to kind of think about that.","Therapist: ""And that's the thinking I'm getting at. It's not necessarily irrational. I'm thinking it's just less than useful. It's dysfunctional.""
Patient: ""Yeah, I can see that.""
Therapist: ""We were talking about that third day, right? The third day of work you had to call off. Do you remember any of the specific thoughts that were going through your mind? Was that a morning when you figured it out, like a Friday morning?""",957.84,968.67
015_115,015,115,4,"Panic. Panic. Worry, yeah. Maybe some anxiety. Some anxiety, yeah.","Therapist: ""So your thought was, am I going to get fired?""
Patient: ""Yeah.""
Therapist: ""And then what was the feeling that came right after that?""",978.35,984.03
015_117,015,117,2,"Um, I did tell myself that I didn't go over yet and, you know, hopefully I won't, you know, there's still a chance that I'm not going to go over on my days and hopefully it won't go so far as to fire me, you know.","Therapist: ""And then what was the feeling that came right after that?""
Patient: ""Panic. Panic. Worry, yeah. Maybe some anxiety. Some anxiety, yeah.""
Therapist: ""Were you able to do anything to address that panic, worry, or anxiety at that time? Like, did you tell yourself anything or did you take some action?""",996.63,1011.52
015_119,015,119,2,"Um, a little bit better but the thoughts still kept hovering around. Yeah.","Therapist: ""Were you able to do anything to address that panic, worry, or anxiety at that time? Like, did you tell yourself anything or did you take some action?""
Patient: ""Um, I did tell myself that I didn't go over yet and, you know, hopefully I won't, you know, there's still a chance that I'm not going to go over on my days and hopefully it won't go so far as to fire me, you know.""
Therapist: ""And how did you feel after you consciously had that thought?""",1018.87,1023.27
015_121,015,121,4,"Yeah. Yeah, like I wanted to call somebody at work and talk to them about it and make sure it was okay. But you know, it was the weekend so I couldn't do any of those things. I just had to wait it out. Yeah.","Therapist: ""And how did you feel after you consciously had that thought?""
Patient: ""Um, a little bit better but the thoughts still kept hovering around. Yeah.""
Therapist: ""The whole time? Probably all the way till Monday, right? Return to work.""",1027.38,1038.73
015_123,015,123,2,"Yes, not useful in that moment.","Therapist: ""The whole time? Probably all the way till Monday, right? Return to work.""
Patient: ""Yeah. Yeah, like I wanted to call somebody at work and talk to them about it and make sure it was okay. But you know, it was the weekend so I couldn't do any of those things. I just had to wait it out. Yeah.""
Therapist: ""So we've talked before about self-talk. You might remember me saying the phrase adaptive response, right? So it's the kind of pre-packaged response we have to thoughts that we've identified as not so useful. Right. So would you agree those thoughts like, am I going to get fired and all that, not very useful in that moment?""",1064.22,1066.25
015_125,015,125,2,"Well, I guess I could say, you know, I didn't, you know, I'm not, I haven't had any conversations with anybody that have indicated that. So sort of like maybe I just need to not worry about it or cross that bridge when I come to it kind of thing. Like hopefully it won't, I don't know if it will happen or not and hopefully it won't happen.","Therapist: ""So we've talked before about self-talk. You might remember me saying the phrase adaptive response, right? So it's the kind of pre-packaged response we have to thoughts that we've identified as not so useful. Right. So would you agree those thoughts like, am I going to get fired and all that, not very useful in that moment?""
Patient: ""Yes, not useful in that moment.""
Therapist: ""Understandable, right, but not useful. Mm-hmm. So what's, now you had sort of some self-talk that you applied on your own. What's some other self-talk? What's some other, another thought that you could think or something you can say to yourself that could counter an automatic thought like that? Like specifically that I'm going to lose my job.""",1091.39,1111.15
015_127,015,127,1,"Yeah, my mom can sometimes. I did call her this week to see if she could take a day, but she couldn't because of what she had going on. But in other times, she might be able to take a day and stay home. Or my sister can do that as well. And my husband can sometimes. It depends on what is going on that week for him at work. So there are some options there.","Therapist: ""Understandable, right, but not useful. Mm-hmm. So what's, now you had sort of some self-talk that you applied on your own. What's some other self-talk? What's some other, another thought that you could think or something you can say to yourself that could counter an automatic thought like that? Like specifically that I'm going to lose my job.""
Patient: ""Well, I guess I could say, you know, I didn't, you know, I'm not, I haven't had any conversations with anybody that have indicated that. So sort of like maybe I just need to not worry about it or cross that bridge when I come to it kind of thing. Like hopefully it won't, I don't know if it will happen or not and hopefully it won't happen.""
Therapist: ""So the self-talk there is there's no clear indication that it's going to happen. Right. So why borrow the worry? How about adaptive behaviors? We talked about the importance of support systems before in other sessions. Is there anybody else that could watch your child if you were really running up against that?""",1130.83,1154.68
015_129,015,129,4,"I did. I did, but just the circumstances didn't work out.","Therapist: ""So the self-talk there is there's no clear indication that it's going to happen. Right. So why borrow the worry? How about adaptive behaviors? We talked about the importance of support systems before in other sessions. Is there anybody else that could watch your child if you were really running up against that?""
Patient: ""Yeah, my mom can sometimes. I did call her this week to see if she could take a day, but she couldn't because of what she had going on. But in other times, she might be able to take a day and stay home. Or my sister can do that as well. And my husband can sometimes. It depends on what is going on that week for him at work. So there are some options there.""
Therapist: ""Did you explore those options for this last time?""",1157.67,1161.73
015_132,015,132,2,"That's really it. You know, when she's sick, that's really it. Because I don't want to put her around any other kids, which is why I wouldn't send her to daycare.","Patient: ""I did. I did, but just the circumstances didn't work out.""
Therapist: ""So none of those individuals were available.""
Therapist: ""Is there any other options you have for care? Or is that it?""",1172.53,1182.2
015_137,015,137,2,"100% sure. Except for my thinking, I was maybe a little not as present as I should have been.","Therapist: ""Okay. And I don't know what you can do in terms of the support. Maybe try to get a better awareness of the schedules when they're available or convey the nature of your problem to them to get some more support. Yeah. So that was one issue. Now, you highlighted more prominently, though, the good mother. I want to touch on that as well. You did everything you had to do to care for your child?""
Patient: ""Yes.""
Therapist: ""Okay.""",1239.77,1247.0
015_142,015,142,2,"I guess it's not ideal, but it's okay.","Patient: ""But behavior, yes.""
Therapist: ""You did everything a good mom would do?""
Therapist: ""Okay. So is it okay, if you're doing everything you need to do, to think thoughts that don't seem congruent with that, you know, that distract you away from that?""",1268.37,1272.4
015_144,015,144,2,"You know, or at least be able to put my worry about the other circumstances aside. for that time period.","Therapist: ""Okay. So is it okay, if you're doing everything you need to do, to think thoughts that don't seem congruent with that, you know, that distract you away from that?""
Patient: ""I guess it's not ideal, but it's okay.""
Therapist: ""It's not ideal. So you'd really rather be, have the ability to be really focused on what's going on with your child to the exclusion of what's going on in other circumstances.""",1286.82,1292.8
015_149,015,149,2,"Um, that I'm doing, I'm behaving, doing the behaviors that I need to do, and the baby doesn't know what I'm thinking, so.","Therapist: ""The more thoughts you have like that, you think of it as like pushing you down toward five.""
Patient: ""Yeah.""
Therapist: ""Okay. So when you have those thoughts, what's an adaptive response or, you know, self-talk? What can you tell yourself in those moments?""",1348.34,1357.98
015_150,015,150,2,"She doesn't know that I'm distracted or worried, so. I'm not doing any harm to her.","Patient: ""Yeah.""
Therapist: ""Okay. So when you have those thoughts, what's an adaptive response or, you know, self-talk? What can you tell yourself in those moments?""
Patient: ""Um, that I'm doing, I'm behaving, doing the behaviors that I need to do, and the baby doesn't know what I'm thinking, so.""",1360.08,1365.29
015_159,015,159,1,"Yeah, it makes sense. And, you know, when you say it, Back to me, the things that I'm saying, it does sound a little bit irrational or unhelpful.","Therapist: ""But we can work to not suffer more than we have to.""
Patient: ""Right.""
Therapist: ""Does that kind of make sense?""",1404.21,1414.74
016_001,016,1,2,I'm all right. I'm a little bit stressed out right now.,"Therapist: ""Hello, Hazel. How are you feeling?""",16.66,20.08
016_003,016,3,4,"Well, as you know, I'm in a graduate program right now, and I'm just really coming to near the end of my program, and I'm just finding it increasingly difficult. I'm just really stressed with how things have been going.","Therapist: ""Hello, Hazel. How are you feeling?""
Patient: ""I'm all right. I'm a little bit stressed out right now.""
Therapist: ""A little stressed? What's going on?""",22.59,38.72
016_005,016,5,4,"Well, I don't really know. It's just I, as I have told you before, I take school really seriously, and I really strive to do well, well in school and well on my assignments, and I just feel like I'm not performing. as well as I need to.","Therapist: ""A little stressed? What's going on?""
Patient: ""Well, as you know, I'm in a graduate program right now, and I'm just really coming to near the end of my program, and I'm just finding it increasingly difficult. I'm just really stressed with how things have been going.""
Therapist: ""Okay, now we've talked about some different struggles you've had as you balance work and school and everything. What specifically is bothering you now? It seems like you're a little more distressed today.""",49.05,69.86
016_010,016,10,4,"Yeah, I just feel like it's getting harder to get the A's.","Patient: ""Well, I've been getting A's.""
Therapist: ""Anything else?""
Therapist: ""Just A's? Okay. That's usually considered pretty good, right?""",85.43,89.44
016_012,016,12,5,Right. It used to be so easy for me. to do what my teachers expect and to get good grades. Now I feel like it's really a struggle and I'm not doing as well as I need to and I'm constantly worried about not doing as well.,"Therapist: ""Just A's? Okay. That's usually considered pretty good, right?""
Patient: ""Yeah, I just feel like it's getting harder to get the A's.""
Therapist: ""Okay, so you're working harder to get the same grade.""",91.64,106.62
016_014,016,14,4,"My teachers all seem to think I'm doing well. I seem to get good feedback on my assignments. But I feel like I feel like I just, to make sure I'm doing well, I really focus on, like, the details, like, making sure that the instructions are really clear. Like, I'm doing everything, like, perfectly as the instructor wants because I'm really afraid that, you know, if I'm not really clear on what the assignment is, then maybe I won't do it the right way.","Therapist: ""Okay, so you're working harder to get the same grade.""
Patient: ""Right. It used to be so easy for me. to do what my teachers expect and to get good grades. Now I feel like it's really a struggle and I'm not doing as well as I need to and I'm constantly worried about not doing as well.""
Therapist: ""Have you been getting any feedback from professors or your classmates about your performance?""",115.95,146.36
016_016,016,16,2,Right. Like I find myself like emailing the teacher like almost like obsessively like trying to clarify the assignment and to make sure do they think I'm doing well in class and whatnot.,"Therapist: ""Have you been getting any feedback from professors or your classmates about your performance?""
Patient: ""My teachers all seem to think I'm doing well. I seem to get good feedback on my assignments. But I feel like I feel like I just, to make sure I'm doing well, I really focus on, like, the details, like, making sure that the instructions are really clear. Like, I'm doing everything, like, perfectly as the instructor wants because I'm really afraid that, you know, if I'm not really clear on what the assignment is, then maybe I won't do it the right way.""
Therapist: ""All right. So before when you got AIDS, you were working hard to do a good job, but... Not to the level of precision in terms of like the detail of the assignment that you are now. Right. You're trying to get more information about the assignments. You're working harder to get the same grade that you used to get before.""",168.1,183.12
016_018,016,18,4,"Well, I guess I'm just feeling that, you know, I've worked really hard this whole program and I don't want to mess it up now or, you know, because if I don't get these grades, then I feel like what was the use? Then I'm going to be ruining all this hard work that I've done this whole program if I kind of, if I don't maintain that level of, you know, like you said, precision, I feel like that I've let myself down or that I'm a failure because I just slacked off at the end of the program and it's so close to being done.","Therapist: ""All right. So before when you got AIDS, you were working hard to do a good job, but... Not to the level of precision in terms of like the detail of the assignment that you are now. Right. You're trying to get more information about the assignments. You're working harder to get the same grade that you used to get before.""
Patient: ""Right. Like I find myself like emailing the teacher like almost like obsessively like trying to clarify the assignment and to make sure do they think I'm doing well in class and whatnot.""
Therapist: ""When you're having this feeling that, I guess it's a feeling of anxiety or stress? Yeah. What's going through your mind? What are you thinking about?""",194.37,228.11
016_020,016,20,2,"Probably less than an A, anything other than an A.","Therapist: ""When you're having this feeling that, I guess it's a feeling of anxiety or stress? Yeah. What's going through your mind? What are you thinking about?""
Patient: ""Well, I guess I'm just feeling that, you know, I've worked really hard this whole program and I don't want to mess it up now or, you know, because if I don't get these grades, then I feel like what was the use? Then I'm going to be ruining all this hard work that I've done this whole program if I kind of, if I don't maintain that level of, you know, like you said, precision, I feel like that I've let myself down or that I'm a failure because I just slacked off at the end of the program and it's so close to being done.""
Therapist: ""So what grade would you have to receive for you to feel like you have failed?""",238.56,241.06
016_022,016,22,2,"I mean, I guess I would be okay with that, but I wouldn't be really happy with it.","Therapist: ""So what grade would you have to receive for you to feel like you have failed?""
Patient: ""Probably less than an A, anything other than an A.""
Therapist: ""And right below an A is an A minus?""",244.81,250.27
016_024,016,24,2,I wouldn't be that excited about that. A B? I wouldn't be happy with that.,"Therapist: ""And right below an A is an A minus?""
Patient: ""I mean, I guess I would be okay with that, but I wouldn't be really happy with it.""
Therapist: ""How about a B plus?""",253.3,261.93
016_026,016,26,3,"Yeah. But a B+, and a B... To me, like, like an A- I would maybe be okay with, but like below that, like to me, like a B is a B, whether it's like a B-, a B-, a B+, it's all a B, and that's not an A.","Therapist: ""How about a B plus?""
Patient: ""I wouldn't be that excited about that. A B? I wouldn't be happy with that.""
Therapist: ""No, that would be worse. Okay. Yeah. So, an A you can tolerate. An A- you're not exactly sure, but you think you could.""",269.96,286.55
016_028,016,28,2,That I didn't try hard enough. That there's something else I could have done to do better. That I was like slacking or I didn't read the directions right or I didn't have enough responses or make my paper long enough. I just didn't do enough.,"Therapist: ""No, that would be worse. Okay. Yeah. So, an A you can tolerate. An A- you're not exactly sure, but you think you could.""
Patient: ""Yeah. But a B+, and a B... To me, like, like an A- I would maybe be okay with, but like below that, like to me, like a B is a B, whether it's like a B-, a B-, a B+, it's all a B, and that's not an A.""
Therapist: ""So what would it mean to you if you received a B?""",292.47,309.43
016_030,016,30,2,"If I didn't try hard enough, then I was lazy.","Therapist: ""So what would it mean to you if you received a B?""
Patient: ""That I didn't try hard enough. That there's something else I could have done to do better. That I was like slacking or I didn't read the directions right or I didn't have enough responses or make my paper long enough. I just didn't do enough.""
Therapist: ""That you didn't try hard enough. That you didn't do enough. What would it mean if that were true?""",320.86,322.94
016_032,016,32,4,"Yeah, that I could have tried harder, and I didn't. So why didn't I try? Maybe I didn't care. I was lazy. Kind of like, what's the use? If you're not going to try your best, then why try at all?","Therapist: ""That you didn't try hard enough. That you didn't do enough. What would it mean if that were true?""
Patient: ""If I didn't try hard enough, then I was lazy.""
Therapist: ""You were lazy.""",326.33,338.59
016_039,016,39,2,"I'm not quite sure. Like, it didn't stress me out as much in the beginning of the program. Like, I really like school, but now I feel like I almost dread it because it's anxiety producing for me because, you know, I'm constantly worried.","Therapist: ""Which, you know, having seen you in these last few sessions, it's clear to me you're not lazy. But that's the thought you're having.""
Therapist: ""Now, it seems that earlier, in your earlier years in the program, this was, the A's were not effortless for you, but you didn't have to work as hard for them.""
Therapist: ""What's, what do you think has changed?""",405.4,419.72
016_041,016,41,2,"The only thing I can think of is we have the same students throughout our program but I guess this semester there's a new student in the program and now that you mention it, it seems like she's kind of really stressing me out.","Therapist: ""What's, what do you think has changed?""
Patient: ""I'm not quite sure. Like, it didn't stress me out as much in the beginning of the program. Like, I really like school, but now I feel like I almost dread it because it's anxiety producing for me because, you know, I'm constantly worried.""
Therapist: ""You mentioned part of it was you're getting close to the end, right? So, is there anything else?""",431.15,450.66
016_043,016,43,4,"Well, see throughout the program I kind of considered myself like to be the student who got the best grades and there's this award at the end of the program for doing really well and I kind of made it a goal of mine to get this award at the end because I felt like that would show that I really tried hard, this program really meant a lot to me, you know, it would show people who viewed it that, you know, I really busted my butt and did a good job in this program and for the whole program so far you know that was me like that was I was kind of the frontrunner I guess for this award and this semester there's a new student and then come to find out like she had a 4.0 in her other program so so if I'm reading you right you you really didn't have any competition for this award that you were aware of right and and now you feel like you really do Right, like I feel like the pressure's on, like I felt like I tried so hard this whole program and now like this new person comes in and she might win it over me. So I really need to go above and beyond to make sure that I'm still on track. So that's the word.","Therapist: ""You mentioned part of it was you're getting close to the end, right? So, is there anything else?""
Patient: ""The only thing I can think of is we have the same students throughout our program but I guess this semester there's a new student in the program and now that you mention it, it seems like she's kind of really stressing me out.""
Therapist: ""How so?""",452.26,532.91
016_045,016,45,4,"Right, and it's causing me a lot of anxiety. with school where it's not as enjoyable for me as it once was.","Therapist: ""How so?""
Patient: ""Well, see throughout the program I kind of considered myself like to be the student who got the best grades and there's this award at the end of the program for doing really well and I kind of made it a goal of mine to get this award at the end because I felt like that would show that I really tried hard, this program really meant a lot to me, you know, it would show people who viewed it that, you know, I really busted my butt and did a good job in this program and for the whole program so far you know that was me like that was I was kind of the frontrunner I guess for this award and this semester there's a new student and then come to find out like she had a 4.0 in her other program so so if I'm reading you right you you really didn't have any competition for this award that you were aware of right and and now you feel like you really do Right, like I feel like the pressure's on, like I felt like I tried so hard this whole program and now like this new person comes in and she might win it over me. So I really need to go above and beyond to make sure that I'm still on track. So that's the word.""
Therapist: ""And paradoxically that's caused you to be more anxious and more stressed and you're performing, well, you're still getting the A's but you're working harder to get the A's.""",545.07,550.96
016_047,016,47,4,"I guess part of me feels like, then why did I do the program? If, you know, part of me feels like if you're not going to be the best, why try? if she got the award over me, then it's kind of like, why did I work so hard this whole time? Like, I could have been slacking this whole time and just skated by, so why did I bust my butt if it was all for nothing? I don't have anything to show for it.","Therapist: ""And paradoxically that's caused you to be more anxious and more stressed and you're performing, well, you're still getting the A's but you're working harder to get the A's.""
Patient: ""Right, and it's causing me a lot of anxiety. with school where it's not as enjoyable for me as it once was.""
Therapist: ""So what would it mean if you couldn't get the award, if you didn't win? What's the name of the new, what's the first name of the new student? Joyce. Joyce, okay. So what if Joyce won this award and you didn't? What would that mean?""",568.14,591.53
016_049,016,49,4,"I mean, I guess it's not the only thing that matters, but part of me feels that way sometimes, that I have these thoughts that if I don't try my hardest and do well and win this award, then why did I try so hard the rest of the time? Like, it negates all the positive things. This, that this, you know, kind of like the end result, like if you tried hard the whole race and then you lose, you know, at the end.","Therapist: ""So what would it mean if you couldn't get the award, if you didn't win? What's the name of the new, what's the first name of the new student? Joyce. Joyce, okay. So what if Joyce won this award and you didn't? What would that mean?""
Patient: ""I guess part of me feels like, then why did I do the program? If, you know, part of me feels like if you're not going to be the best, why try? if she got the award over me, then it's kind of like, why did I work so hard this whole time? Like, I could have been slacking this whole time and just skated by, so why did I bust my butt if it was all for nothing? I don't have anything to show for it.""
Therapist: ""So it's all for nothing if you don't win the award?""",595.99,626.49
016_054,016,54,1,"Right. I didn't even know about the award until probably like the second year anyway. So that wasn't the reason I entered, but...","Therapist: ""Right. You're just not getting an award, which you would like.""
Therapist: ""And which would be great.""
Therapist: ""And certainly an accomplishment. But the reason you came to the program was to get the degree.""",647.75,655.44
016_060,016,60,4,"Right, and I'm not even, I feel like when I read, like I'm so stressed with it. I'm reading the right thing and memorizing every word that I'm not retaining all the information. So it could, and it's starting to, like, impact school.","Therapist: ""Yeah. So this desire to be perfect or to win the award is potentially causing you not even to perform well, right?""
Patient: ""Right.""
Therapist: ""You're still getting the A's, but it's called, you know, the anxiety and you're working hard and...""",724.0,737.12
016_062,016,62,2,"I mean, that kind of sounds silly when you're reflecting it back to me how, you know, that I have to win the awards. Like, I think that it makes sense. You know, that it wasn't my goal going into it. You know, why does it matter so much to me that there's different degrees of success, I think, as you've said before. that it's not all about the award. And I think I would be happy with just, you know, getting the degree and all the stuff that I've learned. And I would feel like it was, if I didn't get the award, rather, I would feel like it was still a worthwhile journey. But in the moment, sometimes it's really upsetting at the thought of not getting the award. But that's a possibility.","Therapist: ""You're still getting the A's, but it's called, you know, the anxiety and you're working hard and...""
Patient: ""Right, and I'm not even, I feel like when I read, like I'm so stressed with it. I'm reading the right thing and memorizing every word that I'm not retaining all the information. So it could, and it's starting to, like, impact school.""
Therapist: ""So, is there any way that you can not win the award and still walk away having accomplished worthy goals? Or does it have to be the award or none of this was worth it?""",754.38,803.61
016_067,016,67,1,I don't think so. I don't think in the long term many people would know about it besides me or if I put it on a resume or something. But I don't think it would make that much of a difference.,"Patient: ""Right, exactly.""
Therapist: ""And in your mind, losing the award invalidates all the hard work you've done.""
Therapist: ""But in reality, there's probably a between ground there, right? A shade of gray where you're still an excellent student, you still graduate, you just don't have an extra plaque to hang on the wall, whatever the award is, right? That's really all you'd be missing. Right. Would this award have any impact on employment?""",837.86,848.57
016_069,016,69,1,"Right. At the beginning, I didn't even know about it.","Therapist: ""But in reality, there's probably a between ground there, right? A shade of gray where you're still an excellent student, you still graduate, you just don't have an extra plaque to hang on the wall, whatever the award is, right? That's really all you'd be missing. Right. Would this award have any impact on employment?""
Patient: ""I don't think so. I don't think in the long term many people would know about it besides me or if I put it on a resume or something. But I don't think it would make that much of a difference.""
Therapist: ""And you didn't even know about it when you first came in. You were already working hard.""",854.24,856.83
016_073,016,73,2,"Right. It makes me, it makes me paranoid to make mistakes or to try and take risks or to really, you know, do well because I'm so worried about, um, judgment, like, from my teachers if I'm doing well enough.","Therapist: ""So in a sense, and of course we can't do this, but in a sense, if you could forget about the award, you'd probably win it.""
Therapist: ""Right. Because you're already doing so well. But it's the thought of this potential failure...""
Therapist: ""Not winning the award, that's holding you back.""",874.28,890.9
016_076,016,76,4,"Right, like I'm walking on eggshells and I'm just expecting my grades to tank if I kind of like deviate from that line.","Patient: ""Right. It makes me, it makes me paranoid to make mistakes or to try and take risks or to really, you know, do well because I'm so worried about, um, judgment, like, from my teachers if I'm doing well enough.""
Therapist: ""Yeah. There's no... There's no tolerance for any type of mistake.""
Therapist: ""So now, now that this award's out there, you really feel like you can't make any type of mistake or you just go right to a catastrophe.""",908.87,916.94
016_080,016,80,4,"If I'm, you mean if I'm, when I'm just doing the work?","Therapist: ""So for you to feel better about this, one way, I guess, would be to not place so much value in winning.""
Patient: ""It's really hard.""
Therapist: ""You really want that. And it would be great. And that's okay. We talked about the adaptive responses before. What's the automatic thought you have when you're sitting there trying to get every assignment right and you're kind of vaguely thinking about not losing or not winning this award. What's the automatic thought that comes to mind?""",958.04,962.22
016_082,016,82,2,"I guess I'm just kind of like running through a checklist. Like, did I do this? Did I do this? Did I do this? Making sure I did everything that was expected of me.","Therapist: ""You really want that. And it would be great. And that's okay. We talked about the adaptive responses before. What's the automatic thought you have when you're sitting there trying to get every assignment right and you're kind of vaguely thinking about not losing or not winning this award. What's the automatic thought that comes to mind?""
Patient: ""If I'm, you mean if I'm, when I'm just doing the work?""
Therapist: ""Yeah, when you're doing your work and you sense that anxiety come on, right, as you start maybe vaguely thinking about winning or losing this award, right? Like it's losing it really. What's going through your mind right at that moment?""",978.05,986.76
016_087,016,87,2,That I must win the award?,"Patient: ""Right.""
Therapist: ""Right. So at a higher level, one of your thoughts is, I must win that award.""
Therapist: ""Does that make sense? I mean, that's probably in there somewhere, I'm thinking, right? It does make sense, yeah. Is there any type of adaptive response you could apply at that moment to that statement? a kind of, well, it's an absolute statement, right? I must win that award. Is there any type of adaptive response you could apply at that moment that could counteract that automatic thought?""",1019.86,1022.0
016_088,016,88,1,"I guess I could say that, you know, the award is something local to my university and no one's going to know about it in the grand scheme of things, so it won't really impact future employment or what my colleagues think of me, you know, if I don't get the award, that they won't think less of me.","Therapist: ""Right. So at a higher level, one of your thoughts is, I must win that award.""
Therapist: ""Does that make sense? I mean, that's probably in there somewhere, I'm thinking, right? It does make sense, yeah. Is there any type of adaptive response you could apply at that moment to that statement? a kind of, well, it's an absolute statement, right? I must win that award. Is there any type of adaptive response you could apply at that moment that could counteract that automatic thought?""
Patient: ""That I must win the award?""",1024.35,1046.05
016_091,016,91,4,"I feel like sometimes I do, and then sometimes it's really hard in the heat of the moment to kind of talk myself down from that kind of spiral of, I'm not doing this assignment right, I'm not doing well, I'm going to get a B in this class, I'm going to lose this award. So I feel like it starts, it's hard in the moment to spiral out of that.","Patient: ""I guess I could say that, you know, the award is something local to my university and no one's going to know about it in the grand scheme of things, so it won't really impact future employment or what my colleagues think of me, you know, if I don't get the award, that they won't think less of me.""
Therapist: ""Okay. So you could say, it'd be nice to win the award, but in the end, it's not really going to make a difference in my life in terms of my career.""
Therapist: ""Right. And that's a fair adaptive response, right? You do want to win it, right? It's truthful. And it would be nice to win it, right? Who doesn't want to win the war, right? But if you don't, you're still a good student, you're still going to be a good clinician, and your career is still going to move on. Do you believe in that adaptive response? Do you believe that adaptive response is true?""",1085.81,1106.01
016_095,016,95,2,Right. Depends on what else is going on in my stress.,"Therapist: ""So what percentage of the time do you believe that adaptive response is true?""
Patient: ""Maybe like half the time.""
Therapist: ""So 50% of the time.""",1115.45,1117.69
016_098,016,98,2,I don't even know if she knows about it.,"Patient: ""Right. Depends on what else is going on in my stress.""
Therapist: ""And the other half, you're not really buying it.""
Therapist: ""Okay. All right. So, what advice, well, let's use Joyce, right? Okay. Joyce is in the same situation, in a sense, in that she's, well, maybe not knowingly, but she's working toward this award as well.""",1141.95,1144.32
016_100,016,100,1,"I think I would tell her that the rest of the class sees that she's doing well. her teachers give her positive feedback, so all signs would point towards that you're doing really well and you're being very successful in the program, that you're getting positive feedback from that. So all the signs, the feedback is telling you you're doing a really good job.","Therapist: ""Okay. All right. So, what advice, well, let's use Joyce, right? Okay. Joyce is in the same situation, in a sense, in that she's, well, maybe not knowingly, but she's working toward this award as well.""
Patient: ""I don't even know if she knows about it.""
Therapist: ""Let's assume she knows about it and she's in a similar situation. What advice would you give her? If she's kind of obsessing about this in the same way that you are.""",1155.7,1181.68
016_104,016,104,2,"I don't know. Sometimes I feel like I just hold myself to a higher standard than I hold other people to. Like if a friend of mine, like Joyce, would come and tell me the same situation, I'd be able to give her a whole bunch of suggestions or some positive feedback, but it's really hard for me sometimes because I hold myself to a higher standard than other people.","Therapist: ""So your advice to her seems positive and uplifting. I want to say your advice to her is more positive uplifting of what you're telling yourself internally.""
Patient: ""Definitely it is.""
Therapist: ""So if that advice is adequate, and I feel like it is, adequate and appropriate for her, why isn't it adequate and appropriate for you?""",1208.95,1233.38
016_108,016,108,2,"Correct. It makes sense in my head, and I would know what to tell someone else, but I don't always believe it when I say it to myself.","Therapist: ""But you would agree your advice to Joyce, as you framed it to me, is useful.""
Therapist: ""But you're just having trouble applying that to yourself.""
Therapist: ""So maybe that's what we need to work on a bit. So you can kind of see the logic of all this, but your feelings don't match.""",1253.79,1261.64
017_003,017,3,4,"Well, last time I started to tell you a little bit about one of my friends, my best friend actually, she had this issue. So what happened was she went to a bathroom at our local library and she found a video camera when she was going to the bathroom.","Therapist: ""And here's what you're doing today.""
Patient: ""I'm okay.""
Therapist: ""What's been going on?""",19.98,39.58
017_005,017,5,2,"That's awful. Yeah. She turned it in to the police, and I guess because she carried it, or she had found it, her handprints were on it, and they weren't able to detect who actually did it. They weren't able to catch the person.","Therapist: ""What's been going on?""
Patient: ""Well, last time I started to tell you a little bit about one of my friends, my best friend actually, she had this issue. So what happened was she went to a bathroom at our local library and she found a video camera when she was going to the bathroom.""
Therapist: ""In the bathroom? Yeah.""",40.94,56.99
017_007,017,7,2,"No. So since then, I've been on really just high alert. I'm worried that that could happen to me, to my kids, and I'm just really worried because they didn't catch the guy that... him or someone like him could be out there.","Therapist: ""In the bathroom? Yeah.""
Patient: ""That's awful. Yeah. She turned it in to the police, and I guess because she carried it, or she had found it, her handprints were on it, and they weren't able to detect who actually did it. They weren't able to catch the person.""
Therapist: ""Oh, they didn't catch the person?""",58.23,73.11
017_011,017,11,2,"A lot of anxiety, just not knowing maybe, you know, what if someone were to videotape me like that. I've been very aware, shall I say, of cameras.","Therapist: ""So he's still out in the community.""
Patient: ""Right.""
Therapist: ""So how is it affecting your daily life? Can you tell me kind of what you've been feeling?""",85.68,99.41
017_013,017,13,2,"Right, like I know you have one in your office and people on their cell phone cameras. Right.","Therapist: ""So how is it affecting your daily life? Can you tell me kind of what you've been feeling?""
Patient: ""A lot of anxiety, just not knowing maybe, you know, what if someone were to videotape me like that. I've been very aware, shall I say, of cameras.""
Therapist: ""Okay, so anxious and aware.""",102.21,110.46
017_014,017,14,4,"Just all the possibilities that I could be recorded. I've just been very aware of them, which makes me not want to go anywhere. So I've been having arguments with my husband a lot because he wants to go out to restaurants and I don't want to go because there could be cameras in the bathrooms. And how I dress also, as you can see, I'm kind of dressed more conservatively because I remember hearing once about cameras that people use on shoes that could be, you know, used in a creepy way. And so I can't, you know, it's now almost summertime. I can't dress in skirts or be comfortable because I'm dressing like that.","Patient: ""A lot of anxiety, just not knowing maybe, you know, what if someone were to videotape me like that. I've been very aware, shall I say, of cameras.""
Therapist: ""Okay, so anxious and aware.""
Patient: ""Right, like I know you have one in your office and people on their cell phone cameras. Right.""",111.82,151.13
017_018,017,18,4,"I would say it's really starting, that's why I wanted to come in, it's really starting to affect my life.","Therapist: ""Right. So you covered a lot of ground there. So you have the feeling of... being worried, nervous that it's going to happen to you. But you've also had to kind of change your routine or you feel you have to change your routine to feel safer. Right. Has that helped? Has changing the way you dress or changing where you go and when you go, has that helped reduce the anxiety?""
Patient: ""Not really.""
Therapist: ""No?""",177.45,182.0
017_020,017,20,4,"He just wants to go places with our kids, like go out to eat. And I don't really want to go anywhere, because cameras are everywhere nowadays. They are? And I just kind of worry, like public bathrooms, could they be there? Could someone be, you know, sometimes baby monitors are hooked to phones and people can hack into that. Laptop cameras. So even in my own house, I've just been really nervous. So I feel like I'm not really getting relief from that anxiety.","Therapist: ""No?""
Patient: ""I would say it's really starting, that's why I wanted to come in, it's really starting to affect my life.""
Therapist: ""You mentioned specifically your husband. Like what's been going on there?""",186.07,215.03
017_022,017,22,4,"I've, you know, when I go into bathrooms, I've been looking for cameras to make sure they weren't there before, you know, me or my children have used the bathroom. I have tried, I read online that you can turn, how to turn off the cameras on your phone. Right. and that you can close your laptop, and that way the camera will face down. And the same thing on a smart TV, so it doesn't recognize your face. I've tried to turn things off that don't need to be on, as far as people being able to access my own information.","Therapist: ""You mentioned specifically your husband. Like what's been going on there?""
Patient: ""He just wants to go places with our kids, like go out to eat. And I don't really want to go anywhere, because cameras are everywhere nowadays. They are? And I just kind of worry, like public bathrooms, could they be there? Could someone be, you know, sometimes baby monitors are hooked to phones and people can hack into that. Laptop cameras. So even in my own house, I've just been really nervous. So I feel like I'm not really getting relief from that anxiety.""
Therapist: ""Have you taken any precautions because of this persistent worry? Other than what you already mentioned, like with the camera specifically, I mean.""",226.1,258.57
017_027,017,27,2,"That there might be a video camera that I don't see, that's maybe, like with my friend it was big enough, but I might not catch it, and that someone's going to use that in a vulnerable way.","Patient: ""Exactly.""
Therapist: ""But still, You have this feeling of worry, anxiety, and your schedule is being interfered with.""
Therapist: ""So you'd like to cope more effectively with your feelings, reduce this anxiety. Right. So when you enter into a public bathroom, and we talked about automatic thoughts before. Yes. Those thoughts just kind of pop into our head and they connect to feelings that can be unpleasant, like anxiety and worry. So when you walk into a public restroom, what's the first thing that goes through your mind?""",311.97,323.12
017_029,017,29,4,"Usually I'll try and find the camera, but it's usually anxiety, fear. My heart rate starts going up. I start getting really anxious. And then, you know, I try and either rush to use the bathroom if I really have to go, or a lot of times if I don't, I'll just leave. Sometimes I try and use the bathroom at home so I don't have to go out.","Therapist: ""So you'd like to cope more effectively with your feelings, reduce this anxiety. Right. So when you enter into a public bathroom, and we talked about automatic thoughts before. Yes. Those thoughts just kind of pop into our head and they connect to feelings that can be unpleasant, like anxiety and worry. So when you walk into a public restroom, what's the first thing that goes through your mind?""
Patient: ""That there might be a video camera that I don't see, that's maybe, like with my friend it was big enough, but I might not catch it, and that someone's going to use that in a vulnerable way.""
Therapist: ""Okay. So when you walk in, you're wondering if there's a camera there. Yes. When that automatic thought occurs, what follows that in terms of a feeling or a behavior?""",336.15,353.81
017_033,017,33,3,"I could say, if when I walk in the bathroom, maybe I could say, you know, while there could be a chance that there's a camera in this bathroom, the chance of it happening is not very likely. And, you know, I'm going to take steps to keep myself safe so that I won't be in a vulnerable position, such as looking for the cameras.","Therapist: ""All right. So your behavior is looking for the camera or sometimes just leaving without using the restroom. Right. And your feeling is that anxiety and worry that we've been talking about. Yes. Okay. So, really if we think about, we talked before about like core beliefs, intermediate beliefs, and I'm wondering if the intermediate belief isn't, I'm vulnerable or This, you know, more specifically maybe, maybe that's more of a core belief, more specifically I'm vulnerable in this area, like with this guy on the loose that, you know, committed that crime. And then, you know, that's combining with situations that you encounter and that's where you're getting those automatic thoughts. Does that sort of make sense?""
Patient: ""Exactly.""
Therapist: ""Okay. So you remember what, in terms of cognitive therapy, we like to apply what we call the adaptive response or self-talk. So it's that thought that you interject at that moment you realize you're having an automatic thought that's going to lead to, in this case, anxiety and worry and behaviors that, well, looking for the camera isn't maybe an unuseful behavior, but leaving, you know, that could certainly be an unuseful behavior. So in terms of that self-talk, let's work to develop a self-talk response, something you could tell yourself, to that initial, you know, I wonder if there's a camera in this bathroom. Okay. What do you think you could tell yourself that would get in between that thought and the feelings you're having?""",461.17,489.33
017_036,017,36,2,"I mean, I think I would be really upset. I think I would feel vulnerable probably for a while and be hesitant. But I mean, I think ultimately I would be okay. My friend, this happened a while ago, she's starting to get over it and get back to her usual routine, although she's still hesitant. So I think I would be Okay, eventually, although I'd be really upset that it happened.","Patient: ""I could say, if when I walk in the bathroom, maybe I could say, you know, while there could be a chance that there's a camera in this bathroom, the chance of it happening is not very likely. And, you know, I'm going to take steps to keep myself safe so that I won't be in a vulnerable position, such as looking for the cameras.""
Therapist: ""But it's good. So you have, you have a low probability of it happening and you're taking useful behaviors to minimize your risk even further. Right. Right. So that's a good automatic thought. Um, I think, or a good adaptive response for the automatic thought rather. Why don't you, why don't you try that one out, right? The next time you have that automatic thought, right? Try out that. You know, I think that's really, you know, that's logical. I mean, it's unlikely to happen. Of course there's a chance, right? Right. And we acknowledge that in the self-talk. There's a chance that it could happen, but there's precautions you can take, and it's a low chance. Right. Sometimes as well, so keep that automatic thought kind of, you know, we'll review it at the end. Okay. Right, before you leave today. We'll write these down. But that's one adaptive response, rather, that I want to write down for you. I also want to talk about like the worst case scenario because right now you have the anxiety and the worry about an event that while it's unlikely it could happen, it could happen.""
Therapist: ""And I'm wondering how you think you would react if the worst did happen, if you used the restroom and you found out from law enforcement or by finding a camera that an offender had been, you know, watching you, right, on a recording. How do you think you would react to that?""",585.36,611.42
017_038,017,38,2,Probably it happened like two months ago.,"Therapist: ""And I'm wondering how you think you would react if the worst did happen, if you used the restroom and you found out from law enforcement or by finding a camera that an offender had been, you know, watching you, right, on a recording. How do you think you would react to that?""
Patient: ""I mean, I think I would be really upset. I think I would feel vulnerable probably for a while and be hesitant. But I mean, I think ultimately I would be okay. My friend, this happened a while ago, she's starting to get over it and get back to her usual routine, although she's still hesitant. So I think I would be Okay, eventually, although I'd be really upset that it happened.""
Therapist: ""And it would make sense to feel upset, right? That would be upsetting for anybody. But as you noted, that would probably be relatively temporary. Right. Distressed, right? Well, acute, and certainly you wouldn't be happy about it and shouldn't be happy about it. Right. It would probably go away. You'd probably learn to adapt. How long have you been in this state of anxiety and worry?""",636.94,639.4
017_044,017,44,4,Right. Because right now I'm suffering every day.,"Therapist: ""Yeah. So if we can compare it, right, we have the chances of being recorded, right, illegally. That's a low probability event. It can happen. Probably not likely. The anxiety and the worry that you're having, that's a high probability event because you're suffering from it every day.""
Patient: ""Yeah, that's true. I never thought about it that way.""
Therapist: ""Right. So there's a, there's a point at which maybe you reach and you say, I'd rather take, I'd rather take the risk, I'd rather deal with the potential consequence of, you know, an unlikely event of being recorded and face that if it happens, than be in the state of anxiety and worry.""",687.24,689.28
017_046,017,46,2,"Maybe, like I said, I'm worried about all the cameras. Maybe I could say, I understand that there's some cameras that are used for good purposes, like security.","Therapist: ""Right. So there's a, there's a point at which maybe you reach and you say, I'd rather take, I'd rather take the risk, I'd rather deal with the potential consequence of, you know, an unlikely event of being recorded and face that if it happens, than be in the state of anxiety and worry.""
Patient: ""Right. Because right now I'm suffering every day.""
Therapist: ""Right now you're suffering, right? Right. And if, if you could adaptively respond, effectively, you know, you're still going to have that risk of being recorded, but you know you could survive that event if it happened. And you're taking reasonable cautions and, you know, all the things we talked about. So, as you think about this in a more general sense, is there an adaptive response you could apply to that automatic thought of, you know, I need to be worried about this, or, you know, whatever that thought looks like. Sometimes the thought's an image, right? It's maybe an image of being recorded. But whatever that kind of general series of automatic thoughts are that are getting you anxious and worried before you even get out of the house, what adaptive response could you apply there?""",737.07,748.76
017_048,017,48,1,"Right. And the chances of being recorded illegally are not likely. And I'm taking precautions to go to the right places, the good areas. So it's not likely to happen overall. And me going outside the house is worth the risk, the minimal risk that it would happen. And if it did happen, I could survive.","Therapist: ""Right now you're suffering, right? Right. And if, if you could adaptively respond, effectively, you know, you're still going to have that risk of being recorded, but you know you could survive that event if it happened. And you're taking reasonable cautions and, you know, all the things we talked about. So, as you think about this in a more general sense, is there an adaptive response you could apply to that automatic thought of, you know, I need to be worried about this, or, you know, whatever that thought looks like. Sometimes the thought's an image, right? It's maybe an image of being recorded. But whatever that kind of general series of automatic thoughts are that are getting you anxious and worried before you even get out of the house, what adaptive response could you apply there?""
Patient: ""Maybe, like I said, I'm worried about all the cameras. Maybe I could say, I understand that there's some cameras that are used for good purposes, like security.""
Therapist: ""Probably most are.""",749.85,777.73
018_003,018,3,2,"Um, well, um, nothing too bad. I kind of got in a little bit of a, like a bender bender accident.","Therapist: ""Hi Rebecca, how are you doing today?""
Patient: ""I'm doing okay.""
Therapist: ""What's been going on?""",22.23,33.22
018_005,018,5,2,"What happened? Um, well, we were at a stop sign and I was like actually red light and um, There was one car here, another car here, and then I was here, another car was behind, coming up behind me, and then they hit me, and then I hit the car in front of me.","Therapist: ""What's been going on?""
Patient: ""Um, well, um, nothing too bad. I kind of got in a little bit of a, like a bender bender accident.""
Therapist: ""A car accident? Yeah.""",35.18,54.92
018_007,018,7,2,"I kind of, you know, you know, just the usual. Rock back and forth. Yeah. Yeah.","Therapist: ""A car accident? Yeah.""
Patient: ""What happened? Um, well, we were at a stop sign and I was like actually red light and um, There was one car here, another car here, and then I was here, another car was behind, coming up behind me, and then they hit me, and then I hit the car in front of me.""
Therapist: ""Oh. Yeah. You okay?""",57.89,63.25
018_009,018,9,2,"No other? I got a couple, you know, little bruises from, like, hitting the steering wheel. I'm like, yeah, but I'm, I mean, I'm okay. My body's okay.","Therapist: ""Oh. Yeah. You okay?""
Patient: ""I kind of, you know, you know, just the usual. Rock back and forth. Yeah. Yeah.""
Therapist: ""But other than that, you're okay?""",64.96,75.13
018_011,018,11,1,"Yeah, everything's okay here. I didn't break anything or pull anything or anything.","Therapist: ""But other than that, you're okay?""
Patient: ""No other? I got a couple, you know, little bruises from, like, hitting the steering wheel. I'm like, yeah, but I'm, I mean, I'm okay. My body's okay.""
Therapist: ""So physically you feel okay? Yeah. Were you, like, checked out by your physician or anything?""",81.76,85.36
018_013,018,13,2,"It's been kind of hard to, like, get in my car again afterwards. Like, I've still been going to work and everything, but, like... I realized last night my boyfriend was like, oh, do you want to go on a trip this weekend? And I was kind of like, maybe not. I'm kind of hesitant to get back in the car.","Therapist: ""So physically you feel okay? Yeah. Were you, like, checked out by your physician or anything?""
Patient: ""Yeah, everything's okay here. I didn't break anything or pull anything or anything.""
Therapist: ""All right. How about emotionally?""",90.19,112.64
018_018,018,18,2,"No, it was being in the car, driving the car. Yeah.","Patient: ""I'm going to get hurt.""
Therapist: ""So it was really all about the car?""
Therapist: ""It wasn't anything else about the trip?""",125.28,129.72
018_020,018,20,4,Yeah. I'm going to get hit. I'm going to get hurt. Yeah.,"Therapist: ""It wasn't anything else about the trip?""
Patient: ""No, it was being in the car, driving the car. Yeah.""
Therapist: ""And the thought was, you're going to get hurt.""",131.41,133.95
018_022,018,22,4,"Oh, definitely. I would have been really excited about it. But now I'm just like, no, I don't. No. Or even coming here, I was like, well, maybe I can reschedule. I was just like, oh, I don't want to travel at all. I don't want to be behind the wheel. I don't want to drive. When I did drive, I was fine. I drove the way I normally do, but I was a little bit more aware. I wasn't driving extra slow. I wasn't driving extra fast or anything, but I was checking a lot more. But very nervous.","Therapist: ""And the thought was, you're going to get hurt.""
Patient: ""Yeah. I'm going to get hit. I'm going to get hurt. Yeah.""
Therapist: ""Yeah. Any other areas that disrupted that trip? So you normally would have went on a trip.""",141.5,176.98
018_025,018,25,4,"Oh, it's fine. I mean, whenever my friends and I would go anywhere, I would always volunteer to drive. I enjoy driving. I like listening to the radio. My family and I always went on trips. And as soon as I turned 16, I always had a turn. I enjoyed it, going on drives, just looking around. But now I don't. I'm too scared. It doesn't even come in my mind anymore. It's a thing I would want to do. If I can avoid it, I will.","Patient: ""Oh, definitely. I would have been really excited about it. But now I'm just like, no, I don't. No. Or even coming here, I was like, well, maybe I can reschedule. I was just like, oh, I don't want to travel at all. I don't want to be behind the wheel. I don't want to drive. When I did drive, I was fine. I drove the way I normally do, but I was a little bit more aware. I wasn't driving extra slow. I wasn't driving extra fast or anything, but I was checking a lot more. But very nervous.""
Therapist: ""Much more nervous than usual?""
Therapist: ""How did you feel about driving cars prior to this accident?""",185.67,215.15
018_027,018,27,4,"Yeah, it takes me a while to actually, like, okay, like, I have to. And then I just kind of do.","Therapist: ""How did you feel about driving cars prior to this accident?""
Patient: ""Oh, it's fine. I mean, whenever my friends and I would go anywhere, I would always volunteer to drive. I enjoy driving. I like listening to the radio. My family and I always went on trips. And as soon as I turned 16, I always had a turn. I enjoyed it, going on drives, just looking around. But now I don't. I'm too scared. It doesn't even come in my mind anymore. It's a thing I would want to do. If I can avoid it, I will.""
Therapist: ""So you're taking every opportunity to avoid, to avoid driving. So far getting, like here today, getting to work, essential functions you've been able to do?""",231.26,240.44
018_029,018,29,4,"Well, it takes me, I have to kind of think about it for a long time. But, I mean, I'm very nervous. I mean, I don't, I can't even really think of what I tell myself. It just kind of happens.","Therapist: ""So you're taking every opportunity to avoid, to avoid driving. So far getting, like here today, getting to work, essential functions you've been able to do?""
Patient: ""Yeah, it takes me a while to actually, like, okay, like, I have to. And then I just kind of do.""
Therapist: ""So what do you tell yourself to motivate yourself to get into the car? like to come here today, for instance?""",247.81,258.87
018_031,018,31,4,"Still pretty scared. Yeah? Yeah, you know, I'm pretty scared throughout the whole thing. You know, I'm always worried that, like, if I can go away that I know that doesn't have any stoplights, I'll try to go that way, even if it takes me an extra half hour.","Therapist: ""So what do you tell yourself to motivate yourself to get into the car? like to come here today, for instance?""
Patient: ""Well, it takes me, I have to kind of think about it for a long time. But, I mean, I'm very nervous. I mean, I don't, I can't even really think of what I tell myself. It just kind of happens.""
Therapist: ""And when you get in the car, like when you kind of work past that nervousness and get in the car, how do you feel then?""",269.5,282.81
018_034,018,34,2,Mm-hmm. Yeah. Yeah.,"Patient: ""Still pretty scared. Yeah? Yeah, you know, I'm pretty scared throughout the whole thing. You know, I'm always worried that, like, if I can go away that I know that doesn't have any stoplights, I'll try to go that way, even if it takes me an extra half hour.""
Therapist: ""Oh, that long?""
Therapist: ""Well, how about now? Like, you've driven here. I presume you're going to drive your own car to wherever you're going next.""",293.78,295.86
018_036,018,36,2,"Yeah. Yeah. Yeah, like you just reminded me of that, and I was like, oh no.","Therapist: ""Well, how about now? Like, you've driven here. I presume you're going to drive your own car to wherever you're going next.""
Patient: ""Mm-hmm. Yeah. Yeah.""
Therapist: ""So does that kind of generate those same feelings in the rest of us?""",301.25,305.04
018_042,018,42,2,"Maybe one small little thing, but this is the worst one I've been in.","Therapist: ""So this is disturbing for you. This is painful for you. Yeah. It's scary. But it hasn't yet infringed on a crucial area of functioning, like your job or something.""
Patient: ""Not yet.""
Therapist: ""But you're worried it might. All right. So prior to this car accident, how many car accidents have you been in?""",334.05,339.72
018_048,018,48,2,"I don't know. This one, it was different because I was by myself. Okay. It was rainy, so maybe that it wasn't, and it wasn't the other before, but...","Patient: ""Maybe like four or five years ago.""
Therapist: ""Were you hurting that?""
Therapist: ""Were you driving? Yeah. So something about this one has triggered this nervousness. The other one didn't. Mm-hmm. What do you think's going on?""",368.12,381.54
018_050,018,50,2,"Yeah, and I was by myself, and then the other one, I had somebody with me. So this one, maybe, I don't know.","Therapist: ""Were you driving? Yeah. So something about this one has triggered this nervousness. The other one didn't. Mm-hmm. What do you think's going on?""
Patient: ""I don't know. This one, it was different because I was by myself. Okay. It was rainy, so maybe that it wasn't, and it wasn't the other before, but...""
Therapist: ""So it was raining in the recent accident, yeah.""",384.41,389.76
018_052,018,52,4,"No. They just, they kind of, they left pretty quickly afterwards, actually, and I was just kind of left to deal with it.","Therapist: ""So it was raining in the recent accident, yeah.""
Patient: ""Yeah, and I was by myself, and then the other one, I had somebody with me. So this one, maybe, I don't know.""
Therapist: ""Did the driver that hit you tell you what happened? Like, why they...""",393.8,402.49
018_056,018,56,4,"And even after, it still kind of feels like... Like... I don't know. Even though I'm not in the car anymore, I'm still like... I don't know. Worried about it.","Therapist: ""Before the police got there?""
Patient: ""Yeah. Really? Yeah.""
Therapist: ""All right. So, this really shook you up. Yeah. And your words can interfere with other areas. Yeah. And what you're thinking is that you're going to get hurt, you're going to get hit. If you get into a car again. And you're thinking it before you get into a car and really... During.""",429.26,440.98
018_059,018,59,2,"It was like 5. It was getting ready to be dark, but it wasn't dark yet.","Patient: ""And even after, it still kind of feels like... Like... I don't know. Even though I'm not in the car anymore, I'm still like... I don't know. Worried about it.""
Therapist: ""Yeah. And it's really worried about another accident.""
Therapist: ""So let's look at that. You were wearing your seatbelt. Yeah. Yeah. All right. And you were driving. It was a little rainy. It was a day or night.""",453.51,457.73
018_063,018,63,2,"Well, always wearing my seatbelt is pretty good. Good idea. Well, I mean, like I said, I try to go ways that don't have stop signs or stop lights, which is hard, but... That's difficult, yeah. I know.","Therapist: ""It wasn't dark, so it was still daytime. Yeah. All right. So, what you're nervous about driving? I mean, driving does carry risk. Okay, so, you know, I can't tell you that there's a way to completely eliminate risk with driving a car. And you know this.""
Therapist: ""having just been in an accident. But there are certainly things you can do to minimize the risks.""
Therapist: ""What do you think some of those things are you could do?""",493.7,509.04
018_065,018,65,2,"Yeah, okay.","Therapist: ""What do you think some of those things are you could do?""
Patient: ""Well, always wearing my seatbelt is pretty good. Good idea. Well, I mean, like I said, I try to go ways that don't have stop signs or stop lights, which is hard, but... That's difficult, yeah. I know.""
Therapist: ""And I'm not sure that would really reduce the risk because you're driving longer.""",512.37,515.31
018_068,018,68,2,Drive when there aren't cars around.,"Patient: ""Yeah, okay.""
Therapist: ""You'd have to look at that case by case, but I see your point. What else?""
Unknown: ""I don't know.""",528.25,530.79
018_069,018,69,2,Drive when there aren't other cars around.,"Therapist: ""You'd have to look at that case by case, but I see your point. What else?""
Unknown: ""I don't know.""
Patient: ""Drive when there aren't cars around.""",531.09,533.09
018_071,018,71,2,"Make sure I don't go too fast or too slow. Make sure that I have space around my car. Make sure all my lights are working, things like that. Make sure I don't have gas so I don't run out of gas or have to stop, things like that.","Patient: ""Drive when there aren't cars around.""
Patient: ""Drive when there aren't other cars around.""
Therapist: ""Which, you know, again, probably is a good idea, but it would be hard to practically implement, right? Yeah. You're driving to work in rush hour and driving home in rush hour. Yeah. Okay, so what about driving habits that you can use?""",551.5,568.97
018_073,018,73,2,"Have a car that has airbags, maybe?","Therapist: ""Which, you know, again, probably is a good idea, but it would be hard to practically implement, right? Yeah. You're driving to work in rush hour and driving home in rush hour. Yeah. Okay, so what about driving habits that you can use?""
Patient: ""Make sure I don't go too fast or too slow. Make sure that I have space around my car. Make sure all my lights are working, things like that. Make sure I don't have gas so I don't run out of gas or have to stop, things like that.""
Therapist: ""So follow all applicable traffic laws. Be aware of your environment. You can do things that will not eliminate, but will reduce the risk of an accident. Now, you were hit while at a red light, right? So that one, of course, the seatbelt would be helpful.""",588.11,592.07
018_077,018,77,2,"Yeah, I might lose my job or my boyfriend wasn't very happy when I said I didn't want to go.","Therapist: ""Certainly the safety of your vehicle, right? A vehicle that's safer than average would be more ideal. Ultimately, I think it's a good idea to be safe, to be aware, to do your best to minimize risk, and at the same time recognize that you can't eliminate it. So there's going to be a point where we have to really work through this nervousness. It's probably actually, I mean in a way, you're looking around more, but ultimately it's probably going to hinder your life.""
Patient: ""Probably. Right.""
Therapist: ""Because you're restricting where you go and all that. Yeah. And eventually if it gets in the way of getting to work.""",638.21,646.59
018_081,018,81,2,"Like, I'm doing everything I can to make sure that I'm safe. Like, I might not be able to prevent getting hit, but I can maybe, like, at least maybe I won't get hurt.","Therapist: ""Yeah, so you don't want to interfere anymore.""
Patient: ""Yeah.""
Therapist: ""So what can you tell yourself? We talked about automatic thoughts, right? Like I'm going to get in an accident. It's really that's That's one of the automatic thoughts. Right. What are some of the adaptive responses that you could apply when that thought comes in? Right, so the adaptive response is that self-talk, that message that you say to yourself. What can you say to yourself?""",676.6,688.73
018_083,018,83,2,"Yeah. Like, it's going to be okay. Like, I don't know. Like, you're safe. You're okay. It's okay. Like, okay, they stopped. Like, just to try to, like, if I see somebody coming behind me and they, and I'm still worried about it, like, noticing that they did stop and reassuring myself that it's going to be okay. It's hard because it's still, you know, fresh.","Therapist: ""So what can you tell yourself? We talked about automatic thoughts, right? Like I'm going to get in an accident. It's really that's That's one of the automatic thoughts. Right. What are some of the adaptive responses that you could apply when that thought comes in? Right, so the adaptive response is that self-talk, that message that you say to yourself. What can you say to yourself?""
Patient: ""Like, I'm doing everything I can to make sure that I'm safe. Like, I might not be able to prevent getting hit, but I can maybe, like, at least maybe I won't get hurt.""
Therapist: ""You could take every precaution.""",690.37,725.77
018_085,018,85,2,"I mean, like, I don't know, too many to count.","Therapist: ""You could take every precaution.""
Patient: ""Yeah. Like, it's going to be okay. Like, I don't know. Like, you're safe. You're okay. It's okay. Like, okay, they stopped. Like, just to try to, like, if I see somebody coming behind me and they, and I'm still worried about it, like, noticing that they did stop and reassuring myself that it's going to be okay. It's hard because it's still, you know, fresh.""
Therapist: ""Yeah, thoughts are strong and you believe them. You believe that you're going to get hurt. It's very real to you. And still there's always that possibility. So, as I mentioned, you can't eliminate the risk. Right. So maybe one way to look at this is that You've only been in one other accident. How many trips have you taken in your life in a car? Like a lot.""",748.74,751.82
018_090,018,90,2,Being careful. Yeah.,"Therapist: ""Scary, certainly. Definitely not fun. Yeah. But they haven't happened too often considering the number of trips you've taken. That's true. Right. So another thing you could do is another adaptive response would be that I'm about to drive a car and there is an element of risk, but statistically... You probably won't get in an accident compared to all the other times I've driven and not been in an accident. Yeah, you probably won't.""
Patient: ""Yeah, that's true.""
Therapist: ""And you can reduce the risk by...""",793.34,797.04
018_092,018,92,2,"I can try. I mean, I, like, I can think of the times where they've come into my head and they're like, like, oh no. And then I'll, if, like, when I realize I'm getting ready to think that, I'll be like, you know what, actually it's going to be okay. And I can try.","Therapist: ""And you can reduce the risk by...""
Patient: ""Being careful. Yeah.""
Therapist: ""So there's a part that you can, of this anxiety, I guess, that you can you can satisfy. Meaning you can say, well, I can really reduce the risks and I know my chances are low in any particular one drive. But there's another part of this that you, of this you kind of have to accept, which is you could, you could be an accident. Yeah. And that's not what you want and you'll do your best to avoid it, but that could still happen. Do you feel like, because I know this is all very fresh, with the accent being recent, do you feel like you can apply those adaptive responses when that, when you identify that automatic thought coming in?""",841.08,854.93
018_099,018,99,2,Yeah.,"Therapist: ""Do you feel like you can complete a few thought records between now and the next session?""
Patient: ""Yeah, I think so.""
Therapist: ""All right, so let's do that. If you feel like that's something you can be all right with.""",962.89,964.89
019_000,019,0,4,"Hi Michelle, how are you doing today? I'm kind of doing... I'm feeling a little bit stressed out.",(Beginning of session — no prior context),15.33,22.24
019_002,019,2,5,"Yeah, I feel like I have a lot on my plate. I have this test that I have to take for work. What kind of test? It's like an aptitude test. It has like math problems on it and like scenarios in order for me to move up to the assistant manager position.","Patient: ""Hi Michelle, how are you doing today? I'm kind of doing... I'm feeling a little bit stressed out.""
Therapist: ""Stressed?""",24.56,43.66
019_004,019,4,4,"Yes, it is. That's what you've been talking about. Yes. All right. So, I've been just feeling a lot of anxiety about taking the test, and then they actually scheduled for me to take the test, and I went, and I just got really overwhelmed, and I started, like, I felt my heart was racing. I felt like I wish my hands were shaking. and I just really couldn't concentrate on the test even though the night before me and my friend did practice problems and I knew all the answers with no problem, like I didn't miss any of the questions.","Therapist: ""Stressed?""
Patient: ""Yeah, I feel like I have a lot on my plate. I have this test that I have to take for work. What kind of test? It's like an aptitude test. It has like math problems on it and like scenarios in order for me to move up to the assistant manager position.""
Therapist: ""All right, and that's a job that you've been interested in for a while, right?""",47.39,88.76
019_008,019,8,2,"No, I wasn't able to complete it and thankfully they gave me a chance to come back. I just told them I didn't feel well. So they rescheduled. So now I'm feeling a lot of anxiety because I'm scared the same thing's going to happen when I go back.","Therapist: ""So you know the material on this test pretty well.""
Patient: ""Yes.""
Therapist: ""But the feelings and that physiological response, the heart rate and the sweating, that The feelings of anxiety plus those physiological responses, they got in the way of you completing it? Like, you weren't able to complete it?""",107.98,120.78
019_010,019,10,2,"The night before, I felt like I know all the answers, but the minute I walked into the room, all of a sudden, all these fears kind of took over.","Therapist: ""But the feelings and that physiological response, the heart rate and the sweating, that The feelings of anxiety plus those physiological responses, they got in the way of you completing it? Like, you weren't able to complete it?""
Patient: ""No, I wasn't able to complete it and thankfully they gave me a chance to come back. I just told them I didn't feel well. So they rescheduled. So now I'm feeling a lot of anxiety because I'm scared the same thing's going to happen when I go back.""
Therapist: ""Alright, so you weren't feeling great about taking the test in the first place.""",127.62,137.19
019_016,019,16,2,"Okay. I had some anxiety the day before, but when I reviewed it with my friend, I'm like, oh, I know the answer, so I thought that would kind of push it down. But I think once I got there, it all came back up to the surface.","Therapist: ""You did, okay. Yes. So you had some anxiety in advance.""
Patient: ""Yes.""
Therapist: ""Or not. You did?""",147.47,162.28
019_018,019,18,4,"Well, I've always kind of struggled with tests. I can remember when I was in third grade, I had to take this test because I was really struggling in math. And I had to pass this test in order to move to the next grade. And I thought, just like this test, that I was ready for it. I had a tutor and I felt really prepared for it. And then when I took it, I failed. And I was held back. And I feel like, you know, that was so, it was really embarrassing for me to be held back. And I felt like, I don't want to say, but I did feel like a failure at the time. Because I felt like I really did know this, so I don't know why I couldn't pass the test.","Therapist: ""Or not. You did?""
Patient: ""Okay. I had some anxiety the day before, but when I reviewed it with my friend, I'm like, oh, I know the answer, so I thought that would kind of push it down. But I think once I got there, it all came back up to the surface.""
Therapist: ""It erupted in that moment and that prevented you. What do you think is leading to this?""",169.97,220.74
019_020,019,20,4,"Yes, I always feel really anxious. I mean, I'm able to pass tests, obviously, because I graduated from grade school and went on to high school. But it's so hard for me because of this anxiety that I feel that even though I may think I know it, I may still fail the test anyway, maybe like a repeat of what happened.","Therapist: ""It erupted in that moment and that prevented you. What do you think is leading to this?""
Patient: ""Well, I've always kind of struggled with tests. I can remember when I was in third grade, I had to take this test because I was really struggling in math. And I had to pass this test in order to move to the next grade. And I thought, just like this test, that I was ready for it. I had a tutor and I felt really prepared for it. And then when I took it, I failed. And I was held back. And I feel like, you know, that was so, it was really embarrassing for me to be held back. And I felt like, I don't want to say, but I did feel like a failure at the time. Because I felt like I really did know this, so I don't know why I couldn't pass the test.""
Therapist: ""And since that, this was third grade? Yes. And since that bad testing experience, have you had trouble with tests since?""",231.32,252.78
019_022,019,22,2,"Yeah, I mean, sometimes I get an A.","Therapist: ""And since that, this was third grade? Yes. And since that bad testing experience, have you had trouble with tests since?""
Patient: ""Yes, I always feel really anxious. I mean, I'm able to pass tests, obviously, because I graduated from grade school and went on to high school. But it's so hard for me because of this anxiety that I feel that even though I may think I know it, I may still fail the test anyway, maybe like a repeat of what happened.""
Therapist: ""All right, so in third grade, you had a really bad testing experience. And as you moved forward from there, you've never really been thrilled about taking tests. No. But you've been able to adapt. You've been able to take them and still pass them.""",275.37,280.17
019_024,019,24,2,"Yeah, I mean, yeah, it is good. Yeah, it's good.","Therapist: ""All right, so in third grade, you had a really bad testing experience. And as you moved forward from there, you've never really been thrilled about taking tests. No. But you've been able to adapt. You've been able to take them and still pass them.""
Patient: ""Yeah, I mean, sometimes I get an A.""
Therapist: ""That's good, right, an A?""",281.17,283.74
019_026,019,26,4,"I think it's just the fact that it's this promotion. It's almost like the same thing, like, if I fail, I'm being held back. And I feel like it's reliving that moment of being held back. And that's like a fear that I have, that by not being able to pass these tests, they're holding me back.","Therapist: ""That's good, right, an A?""
Patient: ""Yeah, I mean, yeah, it is good. Yeah, it's good.""
Therapist: ""But with this particular test, which is not for school, which is for work, this one, this is more of a stomach block for you. Yes. You have any ideas as to what may be making this test such a point of anxiety for you?""",305.9,323.68
019_028,019,28,2,"Yeah, I mean, I didn't put them together until now, but yeah.","Therapist: ""But with this particular test, which is not for school, which is for work, this one, this is more of a stomach block for you. Yes. You have any ideas as to what may be making this test such a point of anxiety for you?""
Patient: ""I think it's just the fact that it's this promotion. It's almost like the same thing, like, if I fail, I'm being held back. And I feel like it's reliving that moment of being held back. And that's like a fear that I have, that by not being able to pass these tests, they're holding me back.""
Therapist: ""Alright, so really that same feeling you had in third grade, that's come out with this test now, right?""",333.36,335.78
019_030,019,30,2,"No, because they didn't have all that pressure that it was either win or lose, basically.","Therapist: ""Alright, so really that same feeling you had in third grade, that's come out with this test now, right?""
Patient: ""Yeah, I mean, I didn't put them together until now, but yeah.""
Therapist: ""And the other tests you'd taken throughout the rest of grade school and high school, they didn't have that same value attached to them.""",345.88,352.53
019_032,019,32,1,Or I could take another test to raise the grade if I didn't do good on that test.,"Therapist: ""And the other tests you'd taken throughout the rest of grade school and high school, they didn't have that same value attached to them.""
Patient: ""No, because they didn't have all that pressure that it was either win or lose, basically.""
Therapist: ""You could take them again or take that course again.""",355.12,360.76
019_034,019,34,1,"Yes, it wasn't fail, you know, pass or fail.","Therapist: ""You could take them again or take that course again.""
Patient: ""Or I could take another test to raise the grade if I didn't do good on that test.""
Therapist: ""So you maybe had more options in school.""",363.65,366.37
019_038,019,38,4,"Yeah, if I fail it, then I'm not going to be able to get the promotion. I would have to wait, just like I did. I'm going to have to wait a certain amount of time, I think an year, before I could take it again.","Therapist: ""Right, so it's the pressure. It's the pressure of you need to get through this.""
Patient: ""Yes.""
Therapist: ""And you don't have the safety nets that you had in school.""",375.6,385.09
019_046,019,46,4,"That I could fail, and then if I fail, I could end up being a failure at all the things that I try.","Therapist: ""There's no time limit? No. How many, is it like a multiple choice? Yes, it is. Okay. And you seem like, like you said, you're studying the night before with your friend. Yes. You're really well prepared for it.""
Patient: ""Yes.""
Therapist: ""So, I have a few thoughts about this. Okay. One is I'm wondering, you know, we've talked before about cognitive therapy, about the core beliefs. So I'm curious as to what you think about what core belief may be operating for you now with this test, this work test.""",437.32,442.62
019_050,019,50,5,"Yeah, I mean that's what scares me. That's exactly the thought that I'm thinking when I'm about to take the test. That if I don't pass it, it's just going to have like this domino effect of failure.","Therapist: ""So something like I am a failure or I'm I'm bound to be a failure, I'm destined to be a failure.""
Patient: ""I would say like I'm destined to be a failure.""
Therapist: ""Okay, so I'm destined to be a failure. So that potentially is a core belief, right, that's operating.""",462.07,471.32
019_056,019,56,2,"No, not really. I mean, sometimes I get worked up when I'm about to take a test, but it's only around tests.","Therapist: ""And the hands shaking. Are you in the room alone when you're taking the test?""
Patient: ""Yes.""
Therapist: ""You are. So no one's really seeing you have this... I wouldn't want to call it a panic attack yet. We haven't really gotten that far into it, but it sounds like it has some panic-like features. Yeah. Because it's not... It's interfering with you thinking clearly enough to get through the items. So, okay. So one thought I have is, have you ever had panic attacks in the past or anything like this? Only when I... the third-grade thing?""",529.17,535.0
019_058,019,58,3,When I actually do take the test? I kind of try to work through it and start trying to answer one question at a time to get to the last question.,"Therapist: ""You are. So no one's really seeing you have this... I wouldn't want to call it a panic attack yet. We haven't really gotten that far into it, but it sounds like it has some panic-like features. Yeah. Because it's not... It's interfering with you thinking clearly enough to get through the items. So, okay. So one thought I have is, have you ever had panic attacks in the past or anything like this? Only when I... the third-grade thing?""
Patient: ""No, not really. I mean, sometimes I get worked up when I'm about to take a test, but it's only around tests.""
Therapist: ""And what happens once you get worked up, like once your heart rate increases and you have the other physiological symptoms?""",543.08,554.49
019_062,019,62,2,And I could also choose like maybe questions that I know the answer to automatically. So that could help maybe. relieve some of that stress.,"Therapist: ""So one possible strategy here is, we talked about the adaptive response, right? So, which is that thought that you say to yourself, that self-talk. I wonder if your adaptive response couldn't be, I can ride this out. Like you have no time to load a test.""
Patient: ""Yeah, that's true.""
Therapist: ""I mean, the panic response is only maintained for so long.""",579.02,587.85
019_064,019,64,1,"Yes, and then I feel like I know, at least I know that, like they'll validate the feeling that maybe I can pass this test.","Therapist: ""I mean, the panic response is only maintained for so long.""
Patient: ""And I could also choose like maybe questions that I know the answer to automatically. So that could help maybe. relieve some of that stress.""
Therapist: ""To get some, in a sense, to get some minor victories under your belt by like answering those right, you know you're closer to achieving your goal.""",595.75,604.98
019_066,019,66,1,"Yeah, definitely, because then I've I start to feel more calm because I know that, I know these questions are definitely going to be right.","Therapist: ""To get some, in a sense, to get some minor victories under your belt by like answering those right, you know you're closer to achieving your goal.""
Patient: ""Yes, and then I feel like I know, at least I know that, like they'll validate the feeling that maybe I can pass this test.""
Therapist: ""So the more items you answer correctly, the less anxious you're going to feel because you're closer to the end.""",614.29,621.36
019_068,019,68,1,"Yeah, that's true. Nobody's there. Nobody's going to see me. I'm kind of trying to get myself together. Yeah.","Therapist: ""So the more items you answer correctly, the less anxious you're going to feel because you're closer to the end.""
Patient: ""Yeah, definitely, because then I've I start to feel more calm because I know that, I know these questions are definitely going to be right.""
Therapist: ""So that's, so that's one, well that's a cognitive and behavioral strategy, right? Like you can, you can wait out the panic. I mean you're in the room alone.""",633.17,638.63
019_070,019,70,2,Okay. So I could use like self-talk.,"Therapist: ""So that's, so that's one, well that's a cognitive and behavioral strategy, right? Like you can, you can wait out the panic. I mean you're in the room alone.""
Patient: ""Yeah, that's true. Nobody's there. Nobody's going to see me. I'm kind of trying to get myself together. Yeah.""
Therapist: ""Now the panic's painful, right? The panic symptoms are painful. So what you could tell yourself is, yeah, this is unpleasant, but I can ride out these symptoms because they only last so long.""",651.46,653.99
019_074,019,74,1,"Yeah, I mean, I've done that in the past, so I can apply it to this test.","Therapist: ""Exactly. Yeah. Because usually panic symptoms can run, you know, five minutes, 10 minutes, 15 minutes, but you have no time limit.""
Patient: ""So I can take it. Yeah.""
Therapist: ""Yeah. So if you can just kind of use that time. to focus on the items, as you mentioned, that you could get right and kind of, at the same time, be telling yourself, I can ride this out.""",678.05,682.88
019_076,019,76,1,"Yes, that has worked for me in the past.","Therapist: ""Yeah. So if you can just kind of use that time. to focus on the items, as you mentioned, that you could get right and kind of, at the same time, be telling yourself, I can ride this out.""
Patient: ""Yeah, I mean, I've done that in the past, so I can apply it to this test.""
Therapist: ""So that's worked for you?""",685.46,689.71
019_080,019,80,1,"So even if I have to take the test again in a year, then I'm not going to be a failure because I still have the chance to take it again. It's not like I'll never be able to take this test again.","Therapist: ""So that's certainly one adaptive response to try, right? Another one could be that although it wouldn't be great to fail, you can retake the test in a year, right? You could try again.""
Patient: ""Yeah, that's true.""
Therapist: ""I mean, I know that's not what you want, but the alternative is kind of buying into that automatic thought. We know that's not working, right? The I'm destined, that was the word, right? Like I'm destined to be a failure. We know that's not working for you.""",723.52,734.64
019_082,019,82,1,"No, no, definitely not. And just thinking back and relating it back to the third grade, even though I had to stay back, I still managed to do well the next year and keep moving up. And it hasn't really, in the long run, prevented me from doing anything that I've wanted to do.","Therapist: ""I mean, I know that's not what you want, but the alternative is kind of buying into that automatic thought. We know that's not working, right? The I'm destined, that was the word, right? Like I'm destined to be a failure. We know that's not working for you.""
Patient: ""So even if I have to take the test again in a year, then I'm not going to be a failure because I still have the chance to take it again. It's not like I'll never be able to take this test again.""
Therapist: ""Yeah, you just have another year to study, right? And, of course, you wouldn't have that promotion that time, and that would be an outcome I know you don't want. But it's not the end of your career. It's not like something so drastic. It's important to you. And I can appreciate that. But it's not the end of your career. You're not going to be unemployed.""",758.79,775.45
019_084,019,84,1,"Yes, I definitely have. Yeah.","Therapist: ""Yeah, you just have another year to study, right? And, of course, you wouldn't have that promotion that time, and that would be an outcome I know you don't want. But it's not the end of your career. It's not like something so drastic. It's important to you. And I can appreciate that. But it's not the end of your career. You're not going to be unemployed.""
Patient: ""No, no, definitely not. And just thinking back and relating it back to the third grade, even though I had to stay back, I still managed to do well the next year and keep moving up. And it hasn't really, in the long run, prevented me from doing anything that I've wanted to do.""
Therapist: ""So that's great. That's another adaptive response, which is I've survived this before.""",780.44,782.52
019_086,019,86,1,Yes. I mean definitely I feel a lot better now because I just know that no matter what happens I've been here before and I can get through it as opposed to like that feeling that I'm going to just fail altogether.,"Therapist: ""So that's great. That's another adaptive response, which is I've survived this before.""
Patient: ""Yes, I definitely have. Yeah.""
Therapist: ""So this one event, I mean, I know you had the incident in third grade with the unpleasant experience, but this one event, you don't want to let this kind of fashion, well, use your word, your destiny, right? Like this was one unpleasant event. It seemed to catch you off guard with the panic-like symptoms. And fortunately, your employer is going to give you a chance to retake it, try this again, and And I imagine you could write out these symptoms and I think you have the other adaptive response which is I've been successful with this before.""",823.5,837.37
019_088,019,88,1,"Next week, next Wednesday.","Therapist: ""So this one event, I mean, I know you had the incident in third grade with the unpleasant experience, but this one event, you don't want to let this kind of fashion, well, use your word, your destiny, right? Like this was one unpleasant event. It seemed to catch you off guard with the panic-like symptoms. And fortunately, your employer is going to give you a chance to retake it, try this again, and And I imagine you could write out these symptoms and I think you have the other adaptive response which is I've been successful with this before.""
Patient: ""Yes. I mean definitely I feel a lot better now because I just know that no matter what happens I've been here before and I can get through it as opposed to like that feeling that I'm going to just fail altogether.""
Therapist: ""All right, so what we'll do is, when do you have to take the test?""",842.79,844.89
019_096,019,96,1,"Yeah, I mean, that sounds good because it helped me prepare for the test.","Therapist: ""And really we'll kind of focus on the positive outcome, right? Okay. Which is just taking this test, taking one item at a time. and fighting through some of these physical symptoms you're having. Okay. And fighting through the unuseful thoughts.""
Patient: ""Okay.""
Therapist: ""Does that make sense?""",877.08,880.3
020_000,020,0,4,"Hi, Jesse. How are you doing today? Not too good, Dr. Grande. Not so good? No, I just got into a fight with my parents. What's been going on? Well, I... I've been doing heroin for a few months now and I didn't think my parents knew but I guess they found a needle in my room and I mean they knew what I was doing and they told me that I have to start shaping up and I need to stop doing any kind of drugs because they said They said the next time that they find any kind of drugs, then that's it. They're going to kick me out of the house.",(Beginning of session — no prior context),14.6,66.94
020_002,020,2,5,"I don't want to be out there. I don't know who would be. I mean, It would be hard just to kind of stop cold turkey, and I know a couple of buddies that did that, and it's not good when you get junk sick. I mean, I'm kind of stuck because I don't know. I don't want to be out in the streets, but it's just going to be so hard, so hard to give it up.","Patient: ""Hi, Jesse. How are you doing today? Not too good, Dr. Grande. Not so good? No, I just got into a fight with my parents. What's been going on? Well, I... I've been doing heroin for a few months now and I didn't think my parents knew but I guess they found a needle in my room and I mean they knew what I was doing and they told me that I have to start shaping up and I need to stop doing any kind of drugs because they said They said the next time that they find any kind of drugs, then that's it. They're going to kick me out of the house.""
Therapist: ""Alright, so they're at the point where anything else happens and they discover it and you're out in the street. Right. What are your feelings about being out in the street?""",79.51,107.15
020_004,020,4,4,"I just... I mean, I don't want to give it up, but I mean, I kind of know I have to. I mean, I'm a young guy. I couldn't make it outside of my parents' house, and I definitely don't want to be out in the streets.","Therapist: ""Alright, so they're at the point where anything else happens and they discover it and you're out in the street. Right. What are your feelings about being out in the street?""
Patient: ""I don't want to be out there. I don't know who would be. I mean, It would be hard just to kind of stop cold turkey, and I know a couple of buddies that did that, and it's not good when you get junk sick. I mean, I'm kind of stuck because I don't know. I don't want to be out in the streets, but it's just going to be so hard, so hard to give it up.""
Therapist: ""There are conflicting feelings here. You don't want to be out in the street. but you don't want to give up the heroin at the same time. Right, right.""",118.08,133.66
020_006,020,6,4,"But to this point, you haven't been able to? I mean, I guess to this point, I really haven't had, like, something that would make me. Like, I've been doing it for a while, and, I mean, it's been pretty great. But, you know, I never really had any kind of, like, problem with it. Nothing too bad has happened, so this is kind of the first time I've been, like, something's hit me where it's like, oh man, I really gotta stop it.","Therapist: ""There are conflicting feelings here. You don't want to be out in the street. but you don't want to give up the heroin at the same time. Right, right.""
Patient: ""I just... I mean, I don't want to give it up, but I mean, I kind of know I have to. I mean, I'm a young guy. I couldn't make it outside of my parents' house, and I definitely don't want to be out in the streets.""
Therapist: ""So you want to stop to avoid the consequences that could happen. Right.""",143.34,175.3
020_008,020,8,2,"I mean, when I first started, it was, I mean, it was pretty freaking great. I mean, the rush that you get from it, it's just mind-numbing, it's just amazing. But I've noticed recently that the rush isn't as intense anymore, and it's even kind of started to backfire a little bit, where I'll actually feel a little sick without using it. And that kind of scares me, but the cravings are definitely still there. Alright, so when you try to cut back, Have you tried to cut back? I have before, but I mean, there was no reason to, so I didn't try very hard. When you did try, did you have the feeling where you were getting sick? I did, yeah. It wasn't as bad as any of my buddies, but I definitely, I mean, I didn't feel well.","Therapist: ""So you want to stop to avoid the consequences that could happen. Right.""
Patient: ""But to this point, you haven't been able to? I mean, I guess to this point, I really haven't had, like, something that would make me. Like, I've been doing it for a while, and, I mean, it's been pretty great. But, you know, I never really had any kind of, like, problem with it. Nothing too bad has happened, so this is kind of the first time I've been, like, something's hit me where it's like, oh man, I really gotta stop it.""
Therapist: ""So this is the first consequent or potential consequence that's motivated you. Right, right. Since you started using. Yeah. How strong is the craving to use?""",188.3,249.01
020_010,020,10,3,"Yeah, I mean, they do. I definitely, like, I don't hold anything against my parents. Actually, I have a pretty good relationship with them. I know what I'm doing isn't good for me, and they said that they would completely support me. They told me that they have a place picked out where I can go and that they'd be willing to pay for it and everything, but they said if I don't,","Therapist: ""So this is the first consequent or potential consequence that's motivated you. Right, right. Since you started using. Yeah. How strong is the craving to use?""
Patient: ""I mean, when I first started, it was, I mean, it was pretty freaking great. I mean, the rush that you get from it, it's just mind-numbing, it's just amazing. But I've noticed recently that the rush isn't as intense anymore, and it's even kind of started to backfire a little bit, where I'll actually feel a little sick without using it. And that kind of scares me, but the cravings are definitely still there. Alright, so when you try to cut back, Have you tried to cut back? I have before, but I mean, there was no reason to, so I didn't try very hard. When you did try, did you have the feeling where you were getting sick? I did, yeah. It wasn't as bad as any of my buddies, but I definitely, I mean, I didn't feel well.""
Therapist: ""Have your parents given you any options in terms of, like, do they understand that you're, it seems like you're a little dependent on it?""",258.54,284.26
020_012,020,12,4,"You know, I think I'm starting to come to terms that it's time to stop. And it might be good that maybe I'm stopping so early. I know my friends have been doing it for a lot longer than I have. But I just, I don't know if the detox is gonna work. I mean, it's hard for me to focus on like anything until, sometimes until I get my next fix.","Therapist: ""Have your parents given you any options in terms of, like, do they understand that you're, it seems like you're a little dependent on it?""
Patient: ""Yeah, I mean, they do. I definitely, like, I don't hold anything against my parents. Actually, I have a pretty good relationship with them. I know what I'm doing isn't good for me, and they said that they would completely support me. They told me that they have a place picked out where I can go and that they'd be willing to pay for it and everything, but they said if I don't,""
Therapist: ""meet them halfway then it's just that's it like it's they're done all right so they have a a solution in a sense for what's going on right like it's like a detox it is okay so they have a they have a solution to help get you off the the heroin but they're still is there still a part of you that doesn't want to go that route i mean i""",315.76,344.33
020_014,020,14,4,Right. It's tough right now because actually my dealer lives in my neighborhood. I mean he's just like a few houses down. My girlfriend lives in our community too and like he's on the way to her house so like I'll kind of just maybe pick it up on my way and throw it in my book bag and then get to hang out with my girlfriend a bit and then maybe on my way back home I'll shoot up with a buddy.,"Therapist: ""meet them halfway then it's just that's it like it's they're done all right so they have a a solution in a sense for what's going on right like it's like a detox it is okay so they have a they have a solution to help get you off the the heroin but they're still is there still a part of you that doesn't want to go that route i mean i""
Patient: ""You know, I think I'm starting to come to terms that it's time to stop. And it might be good that maybe I'm stopping so early. I know my friends have been doing it for a lot longer than I have. But I just, I don't know if the detox is gonna work. I mean, it's hard for me to focus on like anything until, sometimes until I get my next fix.""
Therapist: ""So there's a few problems here. So one is can you commit to go into detox? And the second is even if you successfully complete that, when you come back out, you can avoid the heroin.""",359.14,391.24
020_016,020,16,3,"I mean, it's, like, that house is kind of... That's actually where I shoot up a lot, so it's like, whenever I... It was in his house. Right, right. So it's like, whenever I'm coming up to his house, I'm like... I start getting excited. I start anticipating how great it's gonna feel the next time. And it's like stuck with me. I get excited when it's his house.","Therapist: ""So there's a few problems here. So one is can you commit to go into detox? And the second is even if you successfully complete that, when you come back out, you can avoid the heroin.""
Patient: ""Right. It's tough right now because actually my dealer lives in my neighborhood. I mean he's just like a few houses down. My girlfriend lives in our community too and like he's on the way to her house so like I'll kind of just maybe pick it up on my way and throw it in my book bag and then get to hang out with my girlfriend a bit and then maybe on my way back home I'll shoot up with a buddy.""
Therapist: ""So really you're running into him As you walk to your girlfriend's house. Right, yeah. Yeah, and he's there, and the temptation is great, and...""",407.94,434.81
020_018,020,18,4,"I kind of, I just can't wait for the next hit. Now, I got past his house since my parents had given me the old tomato, and now it's kind of mixed, because I'm like, oh man, if I get to do that, and somehow they find out, like, It's kind of all over for me. But on the other hand, I'm thinking about how great it's going to be. I'm planning in my mind how much I'm going to do and what kind of plans we'll have for the rest of the night.","Therapist: ""So really you're running into him As you walk to your girlfriend's house. Right, yeah. Yeah, and he's there, and the temptation is great, and...""
Patient: ""I mean, it's, like, that house is kind of... That's actually where I shoot up a lot, so it's like, whenever I... It was in his house. Right, right. So it's like, whenever I'm coming up to his house, I'm like... I start getting excited. I start anticipating how great it's gonna feel the next time. And it's like stuck with me. I get excited when it's his house.""
Therapist: ""So you have a feeling. So let's explore this. So as you're walking up to the walls, you're getting ready to pass his house. On your way to your girlfriend. you divert to kind of go to his house, and you have this feeling of excitement. What's the thought that's going through your mind?""",456.47,488.38
020_020,020,20,4,"go into the detox it is yeah it's yeah i mean my my definite plan is to to go into the detox and if if the detox works like i mean i i think i could be done with it but it's just i don't i don't know if the detox can work and i mean i've never i only tried to cut back that one time and I mean, I don't know how good I'll be at it.","Therapist: ""So you have a feeling. So let's explore this. So as you're walking up to the walls, you're getting ready to pass his house. On your way to your girlfriend. you divert to kind of go to his house, and you have this feeling of excitement. What's the thought that's going through your mind?""
Patient: ""I kind of, I just can't wait for the next hit. Now, I got past his house since my parents had given me the old tomato, and now it's kind of mixed, because I'm like, oh man, if I get to do that, and somehow they find out, like, It's kind of all over for me. But on the other hand, I'm thinking about how great it's going to be. I'm planning in my mind how much I'm going to do and what kind of plans we'll have for the rest of the night.""
Therapist: ""Okay, so you have a few things going on. Do you think, like is your plan right now,""",502.98,528.2
020_022,020,22,2,"I don't know if I'll go right back. I think if I can get off it, if the detox actually works like they say it do, I think I can stay off it. I think my cravings will still always be there. But now that I've come to the realization that some of the stuff that I can lose if I get caught, I mean, if I can get off it for good, I don't think I'd go back. It might be hard, like if I run into my buddy or something. That's the point of worry, right?","Therapist: ""Okay, so you have a few things going on. Do you think, like is your plan right now,""
Patient: ""go into the detox it is yeah it's yeah i mean my my definite plan is to to go into the detox and if if the detox works like i mean i i think i could be done with it but it's just i don't i don't know if the detox can work and i mean i've never i only tried to cut back that one time and I mean, I don't know how good I'll be at it.""
Therapist: ""Let's presume for a second that the detox would be successful and you wouldn't be on heroin coming out of detox. Right. Are you worried at that point that you'll go right back?""",548.47,580.2
020_024,020,24,2,"Well, I mean, yeah, definitely I won't. There's so many experiences in his house that kind of... feed into the anticipation and the cravings. I mean, if that doesn't happen, you know, I'll probably help. When are your plans in terms of going into detox? Pretty soon. I think I'm supposed to go on Monday after the weekend.","Therapist: ""Let's presume for a second that the detox would be successful and you wouldn't be on heroin coming out of detox. Right. Are you worried at that point that you'll go right back?""
Patient: ""I don't know if I'll go right back. I think if I can get off it, if the detox actually works like they say it do, I think I can stay off it. I think my cravings will still always be there. But now that I've come to the realization that some of the stuff that I can lose if I get caught, I mean, if I can get off it for good, I don't think I'd go back. It might be hard, like if I run into my buddy or something. That's the point of worry, right?""
Therapist: ""Right. So there is a concern that you could go back if you run into him. Right. But if you could stay away from him, you think you'd increase your chances of being successful?""",592.47,615.22
020_026,020,26,1,"Yeah, I mean, there is. It's kind of out of the way, but I think, yeah, I could go, there's like a horseshoe path. I could, yeah, I could like go up the block and then like around the horseshoe and then I could like turn right and go to her house there. So you would never even see his house. Right, right.","Therapist: ""Right. So there is a concern that you could go back if you run into him. Right. But if you could stay away from him, you think you'd increase your chances of being successful?""
Patient: ""Well, I mean, yeah, definitely I won't. There's so many experiences in his house that kind of... feed into the anticipation and the cravings. I mean, if that doesn't happen, you know, I'll probably help. When are your plans in terms of going into detox? Pretty soon. I think I'm supposed to go on Monday after the weekend.""
Therapist: ""So, like three days. Okay. So, it actually sounds like what your parents have put in place, you believe will work, right? You have confidence it'll work and that your worry is, What worry you have is when you get out, can you avoid your friend? Right, right. You don't buy from anybody else other than your friend? No, no. So that really becomes maybe one of your key goals here, since you sound like you're committed to the detox part. Right. Unless I'm reading that incorrectly. That seems to be something you're... No, yeah. If it works, then I can try. So it's preparing for life after detox. Right. and avoiding, we've heard the phrase people places things with the addictions or substance use. So in this case, you need to avoid, it would seem, your friend and where he lives, right? Which is unfortunately not far from you and in between, like his house is in between your house and your girlfriend's. Right. So is there a way, this may seem a little odd, but is there a way to walk around the block where you can completely avoid his house and still get to your girlfriend's house?""",701.28,719.7
020_028,020,28,3,"I mean, yeah, she's coming over. So maybe if I tell her that it'll help me out, she can make that walk and it'll be easier. Because she can walk right by the house without a problem. Right, right. And I mean, if I start walking out of the house, it'll be harder for me to actually do what I'm supposed to. So if I can't even leave and she comes, that... That might be best. And to get to work, do you have to pass his house? No, not at all. Like, I work down the road, so I just drive. I drive the other way out the community.","Therapist: ""So, like three days. Okay. So, it actually sounds like what your parents have put in place, you believe will work, right? You have confidence it'll work and that your worry is, What worry you have is when you get out, can you avoid your friend? Right, right. You don't buy from anybody else other than your friend? No, no. So that really becomes maybe one of your key goals here, since you sound like you're committed to the detox part. Right. Unless I'm reading that incorrectly. That seems to be something you're... No, yeah. If it works, then I can try. So it's preparing for life after detox. Right. and avoiding, we've heard the phrase people places things with the addictions or substance use. So in this case, you need to avoid, it would seem, your friend and where he lives, right? Which is unfortunately not far from you and in between, like his house is in between your house and your girlfriend's. Right. So is there a way, this may seem a little odd, but is there a way to walk around the block where you can completely avoid his house and still get to your girlfriend's house?""
Patient: ""Yeah, I mean, there is. It's kind of out of the way, but I think, yeah, I could go, there's like a horseshoe path. I could, yeah, I could like go up the block and then like around the horseshoe and then I could like turn right and go to her house there. So you would never even see his house. Right, right.""
Therapist: ""How about other options as well? So there's that option. How about her coming over to where your parents live? Has that ever happened before?""",726.54,760.26
020_030,020,30,1,"Honestly, not that much, no. Obviously, he doesn't really like to leave his house much. He's kind of the only one who lives there. So that's kind of, he just deals out of there and then shoots up there. So he stays in his house most of the time. So now he doesn't even come out.","Therapist: ""How about other options as well? So there's that option. How about her coming over to where your parents live? Has that ever happened before?""
Patient: ""I mean, yeah, she's coming over. So maybe if I tell her that it'll help me out, she can make that walk and it'll be easier. Because she can walk right by the house without a problem. Right, right. And I mean, if I start walking out of the house, it'll be harder for me to actually do what I'm supposed to. So if I can't even leave and she comes, that... That might be best. And to get to work, do you have to pass his house? No, not at all. Like, I work down the road, so I just drive. I drive the other way out the community.""
Therapist: ""So there's kind of some, like, really there's a physical kind of slash behavioral strategy here, which is just physically keeping you away from having to go by his house. And it sounds like the only reason other than to buy and use drugs is to see your girlfriend. And there's an alternative strategy here, right? She'd come to you, or you could go all the way around, and then all the way around back to return. And you get back and forth to work. You don't have to go by his house at all. Yeah, I could do that, actually. Is there ever a time where he comes to you?""",796.38,814.61
020_032,020,32,3,"Bored, okay. Yeah, just straight up. I mean, when there's nothing to do in the house, my parents are gone. So it's the best way to have fun.","Therapist: ""So there's kind of some, like, really there's a physical kind of slash behavioral strategy here, which is just physically keeping you away from having to go by his house. And it sounds like the only reason other than to buy and use drugs is to see your girlfriend. And there's an alternative strategy here, right? She'd come to you, or you could go all the way around, and then all the way around back to return. And you get back and forth to work. You don't have to go by his house at all. Yeah, I could do that, actually. Is there ever a time where he comes to you?""
Patient: ""Honestly, not that much, no. Obviously, he doesn't really like to leave his house much. He's kind of the only one who lives there. So that's kind of, he just deals out of there and then shoots up there. So he stays in his house most of the time. So now he doesn't even come out.""
Therapist: ""And we know that there's automatic thoughts. We talked about this before, right? That there's automatic thoughts that lead to feelings and behaviors. Right. And can you identify a specific thought that may occur, or maybe has occurred, not related to walking by his house, but when you've been in your house, that maybe has motivated you to go walk to his house. Right. I'm bored.""",849.5,858.37
020_036,020,36,2,"I think if I remember to think what I don't want to do when I think that I'm bored, just to kind of come up with something else. So right now, usually my two choices when I'm bored are either to go to my buddy's house or go to my girl's house who's across from my buddy. So maybe that could just be one of the times where I call my girl and be like, hey, can you just come over and we can do something? Just to distract me from wanting to go over to his place.","Therapist: ""So you've identified a thought that directly connects to a behavior you want to avoid, right? So, I'm bored. So, on board leads to using the drugs, right? Because that would alleviate the boredom, right? Right. Is there an adaptive response that you can put in right there, that you can interject right at that moment when you say, on board? Is there an adaptive response you can apply? Let's assume this is post-detox, right?""
Patient: ""Right, right.""
Therapist: ""It sounds like that's your plan. You're sitting in your house. Detox is done. There's no more, you know, we would hope withdrawal-type symptoms. Right. The thought comes upon you, I'm bored. What's a self-talk piece that could be interjected there?""",907.45,938.96
020_038,020,38,1,"Yeah, I mean, she wasn't too happy with me doing it. She doesn't use, so I mean, there's that. So she'll be all on board for that.","Therapist: ""It sounds like that's your plan. You're sitting in your house. Detox is done. There's no more, you know, we would hope withdrawal-type symptoms. Right. The thought comes upon you, I'm bored. What's a self-talk piece that could be interjected there?""
Patient: ""I think if I remember to think what I don't want to do when I think that I'm bored, just to kind of come up with something else. So right now, usually my two choices when I'm bored are either to go to my buddy's house or go to my girl's house who's across from my buddy. So maybe that could just be one of the times where I call my girl and be like, hey, can you just come over and we can do something? Just to distract me from wanting to go over to his place.""
Therapist: ""So the adaptive response is, I'll call my girlfriend. Right, yeah. So I'm bored. And it sounds like what you said, she's really supportive of""",952.26,962.05
020_040,020,40,3,"Yeah, I do. I mean, I, like, as of right now, work's going good, like, school is going good, so I don't, like, I really don't want any problems. And I think, like, now I'm starting to realize that if I do keep using, it's not just going to be something like, that I do when I'm bored or like that I'm doing for fun, it's going to turn into like a problem that's going to kind of affect everything else. So I think like if I just remember to tell myself like when I'm feeling bored, if I just remember to tell myself like I don't want to be out in the streets and like especially I don't want to lose my job. Like I think telling myself those things, it'll help remind me like kind of what's at stake, you know.","Therapist: ""So the adaptive response is, I'll call my girlfriend. Right, yeah. So I'm bored. And it sounds like what you said, she's really supportive of""
Patient: ""Yeah, I mean, she wasn't too happy with me doing it. She doesn't use, so I mean, there's that. So she'll be all on board for that.""
Therapist: ""It seems like consequences motivate you, right? I mean, that's what brought you in today, like to talk about this anyway. So I'm wondering if another adaptive response could involve, you know, I don't want any trouble. And you can substitute a lot of words in for trouble. There's all kinds of trouble that can occur. from using heroin, right? So getting kicked out of your house, I don't want to, you know, I don't want to get kicked out of my house. I'm clean and there's something else I can do here other than drugs, right? Like I'm thinking at times when your girlfriend might not be around. So you still want to have, you want to have an adaptive response that's not necessarily tied to a person in case she isn't around. So you can use that one, certainly, and that's a good one, but when she's not around, and you kind of revisit those consequences in your adaptive response, do you think that's going to be enough motivation to keep you from going to the house?""",1022.23,1069.31
020_042,020,42,3,"Well, I think, like, one of the other things I do to kind of clear my head is I always go for a drive. So, like, if I start feeling bored, I think maybe if I, like, get in my car and, like I said, I don't have to pass his house. If I just drive away, like, just physically leave the temptation and then, like, from there I can go to a bookstore or, like, a comic book store. Like, I could spend hours in there. So maybe if I can remind myself to drive away, go to those stores, and maybe I can just kind of stay out there late enough until either my girlfriend's home or my parents come home.","Therapist: ""It seems like consequences motivate you, right? I mean, that's what brought you in today, like to talk about this anyway. So I'm wondering if another adaptive response could involve, you know, I don't want any trouble. And you can substitute a lot of words in for trouble. There's all kinds of trouble that can occur. from using heroin, right? So getting kicked out of your house, I don't want to, you know, I don't want to get kicked out of my house. I'm clean and there's something else I can do here other than drugs, right? Like I'm thinking at times when your girlfriend might not be around. So you still want to have, you want to have an adaptive response that's not necessarily tied to a person in case she isn't around. So you can use that one, certainly, and that's a good one, but when she's not around, and you kind of revisit those consequences in your adaptive response, do you think that's going to be enough motivation to keep you from going to the house?""
Patient: ""Yeah, I do. I mean, I, like, as of right now, work's going good, like, school is going good, so I don't, like, I really don't want any problems. And I think, like, now I'm starting to realize that if I do keep using, it's not just going to be something like, that I do when I'm bored or like that I'm doing for fun, it's going to turn into like a problem that's going to kind of affect everything else. So I think like if I just remember to tell myself like when I'm feeling bored, if I just remember to tell myself like I don't want to be out in the streets and like especially I don't want to lose my job. Like I think telling myself those things, it'll help remind me like kind of what's at stake, you know.""
Therapist: ""good good so it sounds like you have some some adaptive responses to use another thing occurs to me is your parents around much um yeah i mean they're my dad works a lot my mom's usually home she works too it's like a part-time job so she's usually like home at night and is it at night one of the times when you've gone over to your friend's house well it's actually it's more during the day okay right so she could be an asset in terms of trying to Stop you from leaving the house, but only when she's there right and similar to your father, you know, so it's really I guess we kind of narrow it down to when you're at home alone and Particularly when your girlfriend's not available, that's your highest risk time, right? Yeah, so we have the cognitive Adaptive responses that can be employed, but what if there's anything more behavioral we can do like can you can you go somewhere else?""",1125.56,1166.58
020_044,020,44,1,"Yeah, definitely. I think that'll definitely help, especially being with you right after detox. That'll definitely be the best.","Therapist: ""good good so it sounds like you have some some adaptive responses to use another thing occurs to me is your parents around much um yeah i mean they're my dad works a lot my mom's usually home she works too it's like a part-time job so she's usually like home at night and is it at night one of the times when you've gone over to your friend's house well it's actually it's more during the day okay right so she could be an asset in terms of trying to Stop you from leaving the house, but only when she's there right and similar to your father, you know, so it's really I guess we kind of narrow it down to when you're at home alone and Particularly when your girlfriend's not available, that's your highest risk time, right? Yeah, so we have the cognitive Adaptive responses that can be employed, but what if there's anything more behavioral we can do like can you can you go somewhere else?""
Patient: ""Well, I think, like, one of the other things I do to kind of clear my head is I always go for a drive. So, like, if I start feeling bored, I think maybe if I, like, get in my car and, like I said, I don't have to pass his house. If I just drive away, like, just physically leave the temptation and then, like, from there I can go to a bookstore or, like, a comic book store. Like, I could spend hours in there. So maybe if I can remind myself to drive away, go to those stores, and maybe I can just kind of stay out there late enough until either my girlfriend's home or my parents come home.""
Therapist: ""I think that's a good plan. And remember that the more we apply these adaptive responses, what we hope is that you the risk decreases, like your craving decreases, your motivation to stay clean increases. So while it may be a little inconvenient to drive someplace every time no one's available and you get that thought, that might not be something you have to do forever. But that'll minimize the risk for now, and we want to focus on the short term first, and then we'll worry more about the midterm and long term. Circumstances may change. Maybe he won't reside there forever. Maybe somebody's work schedule will change. Maybe there are other adaptations you can make. Right. But for now, I think this would be a good way to go, just keeping you away from the circumstance that you definitely don't want. Right. So good. There's a few behavioral pieces we have in here and then a few cognitive as well. I want to see you in a couple of days before you go into detox so that we can practice some of these adaptive responses. I'd like you to practice them at home between now and then as well, right? And these behavioral responses as well. But we'll try to get them shored up right before detox and I'll see you right after you come out as well. And we'll make sure that we just keep working on applying and refining these adaptive cognitive responses and these adaptive behavioral responses. Does that sound like a plan?""",1270.7,1277.58
021_000,021,0,4,"Hey, Morty. How are you doing today? I'm doing alright.",(Beginning of session — no prior context),15.14,17.89
021_006,021,6,4,Because we know what you're doing now is not working. That's not working.,"Therapist: ""And instead you stayed in the... the house. Yeah, I mean, it was pretty much my whole senior year. Come home, I knew it was going to happen, and I just took it, you know. I knew he was going to yell, I just took it. Was there ever a period when you first got your freedom that you tried? Oh, yeah. I did, and I don't know. I don't know why I didn't just keep doing that. It probably would have been easier, but I don't know. The whole senior year, I just started... I was just back there at the house when he came home from work. So in that period, were you... Those times when you did leave, what did he do instead of yell at you? I guess he had yelled at somebody else. I mean, my sister, my brother were home. I guess he probably yelled at them. I don't know. I mean, it felt good to not be there, but I guess he probably yelled at them. Which just sucks. I mean, you know, I guess somebody had, whoever was there was going to take it, you know. Somebody was going to get yelled at.""
Patient: ""Yeah.""
Therapist: ""Yeah, I mean, I guess it was them when I wasn't there. I don't know. And how do you think you took it when you were there? How well did you respond? I just got used to it, you know. I knew what was going to happen. I knew he was going to yell. I knew that it was going to make me upset. I knew that just those repeated times, just like now, you know, I'm going to feel like a failure, which ultimately I did, you know. Maybe I just, I probably just became numb to it. You know, it happens so often and same thing every day. Probably just became numb to it and just kind of stopped caring and kind of stopped, I don't know, believing in myself or something, you know. Like you've just given up? Yeah, probably. That's probably, I don't know. Probably, yeah. Yeah. And how many years total did this experience go on? Did you endure the yelling? I mean, it would have been while I was in middle school and most of high school. I mean, I told you at some point I was able to leave, but I mean, probably all of middle school, most of high school, and then I left, and then some, you know, for the rest of the senior year I would be there, so I don't know. Quite a few years, I guess. A long time to suffer. Yeah. And now, if we move back forward in time, you're in a relationship where you're getting yelled at a bit, right? And that's sometimes quite a bit. And that's causing you distress. It's like the same thing. You're yelling a little bit. Yeah. You feel like you're back in the same place. Yeah, I mean, it does. Yeah, I mean, obviously, you know, she's not doing anything like he was, you know, like drinking or anything like that, but it does. I mean, it's like the same thing that happened is happening again, you know? So that's, in your opinion, that's the consequence of what happened to you, like all this yelling that you endured before. in some ways significantly contributing to what you're going through now. Maybe. I mean, I guess it could, you know, because it is the same thing, so maybe it... There could be some connection. Maybe, yeah. I mean... I mean, not 100% explain it, but it explains part of it. Yeah, it definitely could. It definitely could. So, your functioning's been affected a bit. I mean, to the point where you're here with me now, and we're talking about it, and you're frustrated, and it does sound painful. Now, I'm curious. You mentioned you had a younger sister and a younger brother, and they grew up in the same house. How are they doing? Well, my sister, she's three years younger than I am. Still great. I mean, she graduated from college, like, top of her class kind of thing, you know? She's about to get married, too. That's cool. Really great guy. She's doing great. She lives next town over from me. I get to see her a lot. Yeah, she's great, though. My brother, he's five years younger than I am. He's doing pretty good, too. He's just about to graduate from college. I think he gets really good grades, too, from what I hear, from what he tells me. I don't get to see him as much as I do her because he's in college, but I think he's doing really well, too. They both do some really good stuff. They have really good goals and stuff like that. You seem like you have a good relationship with them. You're proud of them. Yeah, definitely. I'm definitely proud of them. I think they're doing some really good stuff. Really... Trying to make something of themselves. Yeah. So, you know, I wonder, they're doing pretty well. You're doing okay, but you're having a rough time right now. How would things have been if you had taken that, you know, I know it's difficult to predict, but if you had taken that opportunity to not be there, If you had, like you said, you had a car, your friends had cars, you could have avoided, you could have avoided the situation directly between your dad and you. Yeah, I mean, yeah, I guess I could have. I don't know, I mean, I mean, I took the, you know, yelling and stuff, so, you know, it's obviously affecting me now. You took the brunt of the abuse. Yeah, I guess I did, I mean. you know I bring it up to them sometimes and they're like yeah I mean dad yelled sometimes but you know it wasn't that bad and definitely a different experience from what I had you know they don't see it like I do you know I don't know maybe I maybe things would have been worse for them so in a sense your father verbally abused you nothing makes that right but in a sense you because you were there and you were the target and could ride it out you shielded them from that abuse yeah i mean you mentioned it would have been somebody else right yeah yeah yeah it probably would have been them probably was them when i wasn't there you know yeah i don't know it's probably right i mean they are doing pretty well you know I think probably they're doing better than I am, I guess. Yeah, probably in no small part because of your, you're protecting them. Right? I mean, you were in an impossible situation and you made the choice to stay there. I guess I did. Right? There was some negative consequences for you, which we'll try to work through. Yeah. But some really positive consequences for your siblings. Yeah, I guess so. I feel like a failure most of the time, but they don't. They're doing good stuff. I guess you're right. That could have been it. I'd love to ask them what they think would have happened if the yelling would have been more towards them. Maybe you'll find out that when you weren't there, that is what happened. So, you feel like a failure, but at the same time you're happy for them and proud of all their accomplishments. Yeah, yeah. It seems like you were a part of that success. Maybe, I mean, I guess it makes sense, you know. Yeah, maybe. I hope so, you know, I hope so. Well, in cognitive therapy oftentimes we try to do we call reframing, right? That's where we take a situation and we don't change the facts, like we don't move from the truth, but we try to cast it in some different lights, right? So it's certainly being yelled at and abused, like I said, nothing makes that, right? That's awful. And what you're going through now, possibly because of that, is awful. And that's a reality. But at the same time, it's a reality, perhaps, that you've protected your siblings. Both those things can be true at the same time. Yeah. Yeah, I guess so. I mean, I guess there's like a positive that comes out of that negative, maybe. Yeah. I hope that's true. I'd like to think it is. Yeah. So another thing that occurs to me is that You were mentioning how before, I think a few sessions ago, how you're being yelled at now, and you're having some strong reactions to that, just like you told me today. But also, you do some of the yelling. Probably. Yeah. Do you think some of that comes from what you learned from your father? Yeah, I mean, I saw him do it for so many years, and it's probably all I know how to do. If I'm trying to resolve something or whatever. Probably all I know how to do. Have there ever been occasions where your wife starts yelling at you and you don't respond with yelling? I think so. That's happened a few times? I guess. I was trying to think of that this week, too, and I was trying to be a little bit more aware, like we were talking about before, about my reaction to her and stuff, and I kind of started to realize a little bit more, like, maybe I'm yelling a little bit more than I think I do, or maybe a little bit more intensely than I think I do. That's probably the case. That's all I knew how to do. That's all I was taught. That's what you learned. So again, just like your father yelling at you, your wife yelling at you isn't what we want. But maybe in that case, maybe your reaction to it is making it worse. Maybe you're contributing to an escalation. Again, because it's what you learned, which is understandable. But perhaps in that moment, and we can talk about your automatic thoughts around that, but Perhaps in that moment, that automatic thought, whatever it is, is contributing to that behavior of yelling back. And we can get in there and try to interrupt that. And maybe get your reaction to be, maybe the more she yells, the more you calm down.""",1167.81,1171.67
022_005,022,5,2,"Yeah, um, well, I guess I'll tell you, but I'm kind of embarrassed to tell you, but, so, like, I'm in college, and all my friends are dating, and I'm just really, like, nervous to just tell you, but, like, I really haven't dated before and I'm really nervous and scared to date and I just don't know how to do it and I don't know. I'm just nervous.","Therapist: ""You're doing good?""
Patient: ""Yeah, okay, I guess.""
Therapist: ""You guess?""",21.8,59.7
022_007,022,7,2,"No, not really. I just was never, you know, that was never enforced in my family. I was never allowed to really do that. So just the thought of it is like, like scary.","Therapist: ""You guess?""
Patient: ""Yeah, um, well, I guess I'll tell you, but I'm kind of embarrassed to tell you, but, so, like, I'm in college, and all my friends are dating, and I'm just really, like, nervous to just tell you, but, like, I really haven't dated before and I'm really nervous and scared to date and I just don't know how to do it and I don't know. I'm just nervous.""
Therapist: ""So nervousness and some anxiety around dating. You said you'd never really dated before.""",68.91,85.11
022_009,022,9,2,"Yeah. So, um, you know, I mean, I tend to talk to guys, but it was just like, like, you know, real short and by like, hi, bye kind of thing because Like I said, that just was never enforced in my family. That was never applauded in when I was growing up. So I never did it. And I was scared to do it for the repercussions of getting in trouble.","Therapist: ""So nervousness and some anxiety around dating. You said you'd never really dated before.""
Patient: ""No, not really. I just was never, you know, that was never enforced in my family. I was never allowed to really do that. So just the thought of it is like, like scary.""
Therapist: ""Scary for you. Yeah.""",86.31,118.94
022_011,022,11,2,"Yeah, just like in my science class, you know, particularly this one time, I actually sat next to this boy who was super cute, but, you know, we would say hi, and that was it. You know, he would try to ask me stuff about the classwork or the assignment, and I would not even look at him and just tell him and look at my schoolwork, and that was the extent of it, you know.","Therapist: ""Scary for you. Yeah.""
Patient: ""Yeah. So, um, you know, I mean, I tend to talk to guys, but it was just like, like, you know, real short and by like, hi, bye kind of thing because Like I said, that just was never enforced in my family. That was never applauded in when I was growing up. So I never did it. And I was scared to do it for the repercussions of getting in trouble.""
Therapist: ""Alright, so no dating in high school. And what type of interactions did you have in high school? You said you said hi a few times.""",129.55,159.24
022_013,022,13,2,"I think it's a little bit of both. I definitely always compare myself to my sisters and they're super pretty and I just don't feel attractive enough to have somebody be interested in me. And if they were to be interested in me, I'm not allowed to date, you know, so the repercussion would just be, you know, I'd kind of be shunned for doing so. It kind of just stayed with me. You know, now I'm 24 and I'm in school and it's just so overwhelming. And I'm kind of envious of my girlfriends because they're able to do it. And I'm like, damn, like how do they do that? So, you know.","Therapist: ""Alright, so no dating in high school. And what type of interactions did you have in high school? You said you said hi a few times.""
Patient: ""Yeah, just like in my science class, you know, particularly this one time, I actually sat next to this boy who was super cute, but, you know, we would say hi, and that was it. You know, he would try to ask me stuff about the classwork or the assignment, and I would not even look at him and just tell him and look at my schoolwork, and that was the extent of it, you know.""
Therapist: ""Let's talk about your anxiety. You have anxiety and earlier like reaction just to thinking about it, right? You think about dating. It's just, it's a lot for you. Do you think this anxiety comes from a fear of what might happen or is this something more how you'll be perceived? Like what do you think is leading to""",190.86,237.82
022_019,022,19,2,"I always do the right thing. I'm really studious. And I like to have fun. I mean, when I'm with my girlfriends, we have a great time. And I'm personable with them and my family. But it's just when it comes to interacting with male, it's just super difficult for me. And I can tell you why, but I can't tell you why. You know, it's kind of that, like it's like a seesaw every time I'm with a male, you know, in a dating aspect anyway. So it's just difficult for me.","Therapist: ""Yeah. It's like a foreign object.""
Patient: ""Like, yeah.""
Therapist: ""So how would you say, how would you describe yourself? Like, how do you feel about yourself?""",257.92,299.16
022_021,022,21,2,"Yeah, like, I don't even know why you're talking to me. Like, why would you talk to me? I'm not pretty. I'm flippin' awkward. Like, you know, why would you even be interested?","Therapist: ""So how would you say, how would you describe yourself? Like, how do you feel about yourself?""
Patient: ""I always do the right thing. I'm really studious. And I like to have fun. I mean, when I'm with my girlfriends, we have a great time. And I'm personable with them and my family. But it's just when it comes to interacting with male, it's just super difficult for me. And I can tell you why, but I can't tell you why. You know, it's kind of that, like it's like a seesaw every time I'm with a male, you know, in a dating aspect anyway. So it's just difficult for me.""
Therapist: ""Is there a particular outcome that you're afraid of? Like when you're, well, you're in college now, right? so likely interact with males to some extent. Is there, when an opportunity comes up, when somebody's interested in you, is there a particular fear that comes to mind?""",322.98,335.44
022_025,022,25,4,Yeah.,"Therapist: ""So you think yourself as unattractive and awkward.""
Patient: ""Yeah.""
Therapist: ""And you question why they would be interested in you.""",343.61,345.69
022_027,022,27,2,"Um, well, yeah, I mean, yeah. people have told me that I'm pretty and, you know, fun and stuff like that. So, yeah, I have.","Therapist: ""And you question why they would be interested in you.""
Patient: ""Yeah.""
Therapist: ""So, have you ever had evidence presented to the contrary? Like people who thought you were attractive and not awkward?""",356.17,373.26
022_031,022,31,2,"I guess just from my, you know, my mom and I think just her roles that I guess I just associated, you know, me not being able to date, that I wasn't presentable enough to date. And I just got this idea that that's the reason why she just didn't want me to date.","Therapist: ""You have. But there's some, so they're telling you that, but there's something else telling you that you're not.""
Patient: ""Yeah.""
Therapist: ""Where do you think that's coming from?""",387.7,407.97
022_035,022,35,2,"They were allowed to date, but under certain circumstances, certain rules, they had to follow. But just when I would, you know, even suggest it to my mom, I was just like, no, you're not.","Therapist: ""So you think her reasoning for not allowing you to date was...""
Patient: ""I wasn't the pretty daughter.""
Therapist: ""Were your sisters allowed to date?""",422.28,435.12
022_037,022,37,4,"I think it was much more strictly. Much more. Yeah, because... It's so much so now that I can't even talk to a guy. It's just, I mean, the anxiety and the fear is so intense. I just can't explain it. It's horrible. That it's not like that for my sisters because now they're married, you know, so they have kids. And it's like, oh, what the heck happened here? And I can recognize it, but I just can't bring myself to do it. Like, talk to somebody or...","Therapist: ""Were your sisters allowed to date?""
Patient: ""They were allowed to date, but under certain circumstances, certain rules, they had to follow. But just when I would, you know, even suggest it to my mom, I was just like, no, you're not.""
Therapist: ""So you feel like you were, of you and your sisters, you were the one treated the most strictly on that? Yeah. But was it much more strictly or just a little differently?""",448.69,478.99
022_043,022,43,2,That I'm unlovable. Unlovable. Yeah.,"Therapist: ""So you have evidence that says that men would be interested in going out with you, dating you, but internally these thoughts you're having say you're just not worthy. It's kind of a theme of it, right?""
Patient: ""Yeah, absolutely. That's it.""
Therapist: ""And maybe... Maybe this is tied to a core belief, like we talked about core beliefs before in cognitive therapy. Are there any of those core beliefs in the list I gave you a few weeks ago that kind of stood out that you think might be core beliefs you have?""",528.22,530.26
022_051,022,51,2,"That's like, it's like, what is it? Fight or flight kind of feeling? Like, it really is. It's like, oh, you know. Yeah. Just something comes over me where, you know, it's kind of like I'm conditioned. Because I don't even live with my mom and my dad now. And I'm on my own. But yet I still hold their values. And that just, all I can just think of is being in high school and having, being told I can't do that. Or, you know, just the rules and having to follow it. And that's really where I feel like I'm there. If someone says something to me.","Therapist: ""So unlovable and a fear of being rejected. And then when you have interactions in the moment, like say you're in class and there's a man that's sitting next to you in class. And they're interested in you. He's interested in you. And he says something that expresses that he's interested. You're immediately suspect.""
Patient: ""Oh, yeah.""
Therapist: ""That's what you're... Oh, yeah.""",584.24,622.21
022_055,022,55,3,"No, they haven't. Not really. No, because they, my mom really wants me, she, I guess, well, maybe it has to do with that, like, I'm smarter than my sisters. So, she really wants me to be a doctor. And my sisters, they have great jobs. But they just stopped at a bachelor's degree. And I'm really working to be a doctor. And I always had straight A's in high school. And my sisters didn't. So I think that my mom wants to hold onto that hope that I'm going to be something great. So she doesn't really enforce the dating thing with me. I guess she's for fear that that's going to get in the way.","Therapist: ""It takes you right back there.""
Patient: ""Yeah.""
Therapist: ""All right. So, how do your parents feel about now? Like, have they said anything like, you know, your sisters are married and you're not? Have they pointed that out?""",635.51,682.38
022_059,022,59,2,"Yeah. I mean, I guess, yeah.","Therapist: ""So that's different than being unlovable, right?""
Patient: ""Well, yeah, I guess.""
Therapist: ""Yeah, I mean her reasoning, as you're describing her reasoning, sounds more like she wants you to reach a higher educational goal.""",705.85,707.91
022_061,022,61,2,"I want to be in a relationship with somebody because all of my friends are, and I'm always a third wheel, and it's difficult. I mean, yeah, I want the education, don't get me wrong, I want a great job, but I don't want to do that alone. I want to have somebody with me that I can confide in and just a confidant, and the time is now, I'm ready, you know. And maybe my mom was just protecting me, I guess, I don't know what she was doing, but I really don't care because I really want to try it. I just don't know how.","Therapist: ""Yeah, I mean her reasoning, as you're describing her reasoning, sounds more like she wants you to reach a higher educational goal.""
Patient: ""Yeah. I mean, I guess, yeah.""
Therapist: ""What do you want?""",710.5,745.78
022_067,022,67,2,"Yeah. Yeah. Because it's... I just keep thinking of the repercussions, like, now as an adult that my mom's just... I guess that she wouldn't talk to me, but I'm not in high school anymore, so... I don't know. I honestly don't know what the conversation would be like if I talked to a guy that I was interested in or if a guy was interested in me. I mean, because I came to the realization, and my friends have helped me with this, that I am in college, I am an adult now, and what my mom thinks is what she thinks. Now it's just me being in front of a male that I'm attracted to, that I want to go out with,","Therapist: ""You do?""
Patient: ""Alright.""
Therapist: ""Yeah. clear goals and that's one force. And then this opposing force is this, well one of them would be this anxiety that comes over you in the moment when a man's talking to you. Like in that way, right? Like about going out or any topic like that. So a part of you is saying, I really want to move forward and date different people and see if I can find a good match. And another part of you is saying, I need to run away. Like you said, fight or flight, right? I want to run away. Yeah. And not have this awkwardness, this anxiety.""",803.39,851.34
022_069,022,69,2,"I don't know. I don't know if it's going to be bad, but... You don't know if it's going to be good either. Yeah.","Therapist: ""Yeah. clear goals and that's one force. And then this opposing force is this, well one of them would be this anxiety that comes over you in the moment when a man's talking to you. Like in that way, right? Like about going out or any topic like that. So a part of you is saying, I really want to move forward and date different people and see if I can find a good match. And another part of you is saying, I need to run away. Like you said, fight or flight, right? I want to run away. Yeah. And not have this awkwardness, this anxiety.""
Patient: ""Yeah. Yeah. Because it's... I just keep thinking of the repercussions, like, now as an adult that my mom's just... I guess that she wouldn't talk to me, but I'm not in high school anymore, so... I don't know. I honestly don't know what the conversation would be like if I talked to a guy that I was interested in or if a guy was interested in me. I mean, because I came to the realization, and my friends have helped me with this, that I am in college, I am an adult now, and what my mom thinks is what she thinks. Now it's just me being in front of a male that I'm attracted to, that I want to go out with,""
Therapist: ""And what you said is you don't know what would happen. So you don't know that it would be bad. You don't know that it would be a bad experience.""",862.4,867.86
022_071,022,71,2,"Well, I mean, like I said, I think because my mom didn't let me date that it was a sign that I was unattractive. So I could take it that way that I was just unattractive. Then he wouldn't initiate at the date if I was unattractive. Good point. So, for that, I was, it just didn't work, you know? There just wasn't anything in common with what I'm about, you know? That I have different hobbies and he has different hobbies and maybe they just don't mesh well and I have to. That could be a reason why it didn't work. Not that I'm, I guess, not unlovable, you know? I shouldn't take it that personal, but it's hard.","Therapist: ""And what you said is you don't know what would happen. So you don't know that it would be bad. You don't know that it would be a bad experience.""
Patient: ""I don't know. I don't know if it's going to be bad, but... You don't know if it's going to be good either. Yeah.""
Therapist: ""So there's a risk, right? So in this situation you're in, if you can get through that anxiety and have a conversation, it could end up where things went very well or didn't. Right. So what happens if it doesn't go well?""",892.05,942.89
022_075,022,75,2,"I think, I think I can, you know. Yeah. I mean, because in essence I was, you know, rejected by my mom, but I'm, I still moved forward with my life. Because since she didn't let me date, that's, a rejection from her that I'm not worthy. So yes, I think Ken, because my friends have helped me. So that's a step in the right direction.","Therapist: ""It's difficult for you. This is painful for you. Yeah, it is. You're fighting through some strong feelings. You try to look at the logical, right? It's likely you, just because of the way it works, you'd have to date several people to find somebody that was a match, right? So some of those relationships you'll end, maybe some of them, The man will end, but eventually one, likely, you would stumble on, or neither one of you would end it. Right? So there's, there's risk involved here. There's a risk of rejection, right? There's a risk of having to reject. Yeah. Right? That doesn't seem to be the risk you're most worried about, though. You're more worried about the risk of being rejected. Yeah. Okay? Because you're questioning their intent. Yeah. Yeah.""
Patient: ""Yeah.""
Therapist: ""So can you survive being rejected?""",1007.09,1037.7
022_079,022,79,2,"Yeah, yeah, it is just one person.","Therapist: ""And you took that behavior from your mother as a rejection. And it seems like that may not have been her reason for doing that. You don't know for sure.""
Patient: ""Yeah.""
Therapist: ""But even if it was, which it seems unlikely it would have been, that's still just one person.""",1057.09,1059.27
022_081,022,81,1,"Yeah, absolutely, right? Because my friends think I'm worthy, right?","Therapist: ""But even if it was, which it seems unlikely it would have been, that's still just one person.""
Patient: ""Yeah, yeah, it is just one person.""
Therapist: ""So if we just take it to the extreme and say, for some reason, you know, she didn't think you were worthy, that's just one person's opinion.""",1067.42,1071.24
022_087,022,87,2,"Yeah. Yeah, absolutely. A lot of that.","Therapist: ""So if you really look at it and weigh the evidence and look at it logically, the balance of the evidence would say that you are worthy, right? You're not unlovable, but still in any type of relational situation there's going to be rejection. So there's potential pain up ahead, but the reward could be you find somebody that you want to be with and that's really your goal.""
Patient: ""Yeah.""
Therapist: ""Yeah. So really part of this is pushing through a good deal of uncomfortableness, discomfort, right?""",1116.46,1119.08
022_089,022,89,3,"Yeah. Yeah. And I think that I'm willing, I'm willing to do it because I want it so bad that, you know, I have to, you don't know until you try it and I have to try it. I have to.","Therapist: ""Yeah. So really part of this is pushing through a good deal of uncomfortableness, discomfort, right?""
Patient: ""Yeah. Yeah, absolutely. A lot of that.""
Therapist: ""A lot of it.""",1120.26,1132.58
022_091,022,91,2,"Well, I would introduce myself, because I have never done that before, to a guy where I introduce myself. I wouldn't even make eye contact, so I think to just look up at them and just say, you know, hi, my name is, you know, Leia, and... just seeing what that feels like, because I don't know what that feels like. You've never reached that step?","Therapist: ""A lot of it.""
Patient: ""Yeah. Yeah. And I think that I'm willing, I'm willing to do it because I want it so bad that, you know, I have to, you don't know until you try it and I have to try it. I have to.""
Therapist: ""So let's set up kind of a behavioral experiment. So let's take it one step at a time. Let's say that, back to that situation I alluded to earlier, you're in class and there's somebody that's interested in you, sitting next to you, or wherever they are, and they come and initiate a conversation. What's your reaction now? What would you do now?""",1159.66,1180.92
022_093,022,93,2,"No, I haven't. Because I wouldn't even, you know, I wouldn't even look them in the eye, because it's just the way it was.","Therapist: ""So let's set up kind of a behavioral experiment. So let's take it one step at a time. Let's say that, back to that situation I alluded to earlier, you're in class and there's somebody that's interested in you, sitting next to you, or wherever they are, and they come and initiate a conversation. What's your reaction now? What would you do now?""
Patient: ""Well, I would introduce myself, because I have never done that before, to a guy where I introduce myself. I wouldn't even make eye contact, so I think to just look up at them and just say, you know, hi, my name is, you know, Leia, and... just seeing what that feels like, because I don't know what that feels like. You've never reached that step?""
Therapist: ""No.""",1181.02,1188.35
022_095,022,95,2,"Right. I mean, I guess that would be really shallow if they did that, so.","Therapist: ""No.""
Patient: ""No, I haven't. Because I wouldn't even, you know, I wouldn't even look them in the eye, because it's just the way it was.""
Therapist: ""So your current reaction is to not look them in the eye, not engage in the discussion, and just kind of shy away. So the behavioral experiment is to not do that, but instead, kind of proactively engage in another behavior, which would be to introduce yourself. So let's just make that the experiment. You seem like you're pretty comfortable and you have some confidence you could do that, right? And that's not a particularly long amount of time. You just have to get through that introduction. And the worst that they could do if you introduce yourself, I mean, I guess they could reject you at that point, That seems pretty unlikely, I mean, you're just, you're just introducing yourself, right?""",1238.58,1242.38
022_097,022,97,2,"Oh yeah, it's all new. And it's like, it's embarrassing, but I feel, I feel like safe with you, so I feel okay that I'm able to talk about it, and like my friends know, you know, but like 24 and never really introducing yourself to a guy is... It's embarrassing. It's embarrassing. Yeah.","Therapist: ""So your current reaction is to not look them in the eye, not engage in the discussion, and just kind of shy away. So the behavioral experiment is to not do that, but instead, kind of proactively engage in another behavior, which would be to introduce yourself. So let's just make that the experiment. You seem like you're pretty comfortable and you have some confidence you could do that, right? And that's not a particularly long amount of time. You just have to get through that introduction. And the worst that they could do if you introduce yourself, I mean, I guess they could reject you at that point, That seems pretty unlikely, I mean, you're just, you're just introducing yourself, right?""
Patient: ""Right. I mean, I guess that would be really shallow if they did that, so.""
Therapist: ""Yeah, but I mean, that's not a great indicator that they would, they would be a suitable mate, right? Yeah. So, um, you introduce yourself and you're open, I guess the second part would be you're open to whatever conversation comes next. Yeah. So you're not committing to anything, right? Um, you're not committing to an engaged, like a long engaged social interaction, you're just saying, here's my name, what's your name, or whatever, and just seeing where the conversation goes. Yeah. So this is really all new.""",1277.41,1296.04
022_105,022,105,1,Yeah. I think so. Absolutely. Yeah.,"Therapist: ""So there's a trade off.""
Patient: ""Yeah.""
Therapist: ""But my guess is the more you introduce yourself, the less that anxiety will be.""",1311.39,1314.47
022_109,022,109,2,Yeah. And I'm always early.,"Therapist: ""So let's just, let's just start with that. Okay. Right. Um, let's start with that. And when's the next time you'll be in the class?""
Patient: ""Actually, next week.""
Therapist: ""Okay, next week. So you'll have the opportunity in that class to introduce yourself to who's there?""",1330.87,1333.09
022_111,022,111,2,"Always early, because, you know, I have to make sure that I'm getting grades, but yeah, I'm always early, so.","Therapist: ""Okay, next week. So you'll have the opportunity in that class to introduce yourself to who's there?""
Patient: ""Yeah. And I'm always early.""
Therapist: ""You're always early?""",1334.21,1339.76
022_114,022,114,2,"Yeah. Yeah, absolutely. Because it would be a victory. Kind of like peeling off layers from my adolescence. Yeah, I guess I would think.","Patient: ""Always early, because, you know, I have to make sure that I'm getting grades, but yeah, I'm always early, so.""
Therapist: ""It's good to be early, okay. So you're always early, and this way, you know, people come in, right, one at a time, whatever, and you can introduce yourself? Yeah, yeah. And that's really, for this first experiment, That and just being open to whatever conversation comes next. And just talking.""
Therapist: ""So, try not to borrow any worry into the future past that. Like in terms of, will they like me? What will they think of me? Where will this go? Just focus on the introduction and the conversation. And try to enjoy that. I know there's some anxiety with it, certainly. A lot. But try to enjoy that experience. And try to look at it as a victory. It's an important step for you to overcome this initial contact fear. So if you can get through that, the possibilities are wide open.""",1403.05,1412.5
022_120,022,120,2,"Yeah, it does. I'm anxious, but it's a positive anxious now, I think.","Therapist: ""Again, if you're not, that's okay. You might be focused on thinking about what they're saying, and that's good. But if you can recollect anything after the fact, like, well, you know, I was thinking that He might not want to talk to me, and he did. Or you're thinking, again, thoughts of not being lovable, thoughts of unlovability. Keep track of those thoughts. That's secondary to the behavior. Introduce yourself and have the conversation if one happens. But if you can also maybe note some of those thoughts, the best time is right after the conversation's over. Just quickly write them down. Kind of what happened, and what you're thinking, and to it. To some extent, what you're feeling, if you remember that. Okay. And I think it would be good for us to kind of track that as you work to overcome this first obstacle.""
Unknown: ""Okay.""
Therapist: ""Does that sound good?""",1485.58,1493.11
022_122,022,122,2,"I am, yeah. Because I want it so bad.","Therapist: ""Does that sound good?""
Patient: ""Yeah, it does. I'm anxious, but it's a positive anxious now, I think.""
Therapist: ""So you're looking forward to it, in a way.""",1495.97,1500.69
022_126,022,126,1,"Okay, perfect. Thank you. Thanks, Diane. Thank you.","Therapist: ""So you start school next week? I do. And I'll see you in a week. And we'll go over kind of what happened from that first day of school. Okay. If there's no opportunity, there's not much to talk about, there's usually not many people to talk to, that's fine. I mean, we'll have opportunities later. But try to introduce yourself to those that you see. Okay. whether you have an interest in them or not, just to get comfortable with introducing yourself. Okay. So have something to discuss and build upon as you move into your second week of school.""
Patient: ""Okay. Yeah, definitely.""
Therapist: ""Okay. So I'll see you in a week and we'll go from there.""",1547.52,1549.91
023_003,023,3,2,"Yeah, I guess so.  I've been working still on the fear of leaving the home for extended periods of time, like vacation.  And it's been a little harder recently because I have this planned trip with a friend of mine coming up in a few months.  And that's kind of been weighing on my mind.","Therapist: ""www.thezeitgeistmovement.com  Hey Ann, how are you doing today?""
Patient: ""Good.""
Therapist: ""Doing well?""",18.0,33.94
023_009,023,9,2,"Yeah, I'm not sure with work and school and everything I can make the full six days.  Plus I'm a little nervous to go that long.","Therapist: ""And how long will you be there?""
Patient: ""She wants to go like six days.""
Therapist: ""Six days?""",42.68,50.48
023_011,023,11,2,"Actually last, just a few days ago she messaged me and said,  hey you want to go with me and we'll go golfing and swimming.  I love golfing, like I, you know, I want to go.","Therapist: ""Six days?""
Patient: ""Yeah, I'm not sure with work and school and everything I can make the full six days.  Plus I'm a little nervous to go that long.""
Therapist: ""That's a long time for you.  It is, yes.  Yeah. So when did you discover this trip was going to be?""",57.98,67.8
023_013,023,13,2,"But I just had these, just, you know, a little nervous about leaving.","Therapist: ""That's a long time for you.  It is, yes.  Yeah. So when did you discover this trip was going to be?""
Patient: ""Actually last, just a few days ago she messaged me and said,  hey you want to go with me and we'll go golfing and swimming.  I love golfing, like I, you know, I want to go.""
Therapist: ""Mm-hmm.""",68.44,73.14
023_015,023,15,2,"God, I can't go that long.  That was my first thought.  That's too long.  But then it was like, wow, this would be great.  I want to go down there golfing so bad  and get away from the cold weather.  So, I mean, my immediate thought was no, not that long,  but yes, I want to go.","Therapist: ""Mm-hmm.""
Patient: ""But I just had these, just, you know, a little nervous about leaving.""
Therapist: ""Little nervous?  Mm-hmm.  So when she made that call, that was just a couple days ago?  Mm-hmm.  What was the first thought you had?""",83.26,98.88
023_019,023,19,2,"I want to go, to go, but maybe not for six days.  Maybe just like a long weekend.","Therapist: ""All right, so you said two kind of conflicting thoughts,  right?  So one is I could never go that long,  six days, way too long.  And the other one is that would be enjoyable.  You'd enjoy that.""
Patient: ""Absolutely.""
Therapist: ""Yeah.  So which way are you leaning right now?""",116.8,122.62
023_021,023,21,2,"Two would be ideal.  Two?  Two would probably be ideal, but two, three days, yeah.","Therapist: ""Yeah.  So which way are you leaning right now?""
Patient: ""I want to go, to go, but maybe not for six days.  Maybe just like a long weekend.""
Therapist: ""Three, four days?""",126.34,131.4
023_023,023,23,2,"I don't know.  always, as a late teenager in my 20s, I've always had just nervous to leave home. I don't,  as much as I love being home, I love to travel too and, you know, do different things. It's  just, I guess I'm just afraid something will happen when I'm not around.","Therapist: ""Three, four days?""
Patient: ""Two would be ideal.  Two?  Two would probably be ideal, but two, three days, yeah.""
Therapist: ""All right.  So what do you think is causing this worry  about being gone more than two days?""",140.4,157.0
023_025,023,25,2,"Well, I have pets so I worry about them. My parents are getting older so I worry about  them. Mainly like my immediate family. Mainly I guess my dad because he's had a  history of heart attacks and then my pets. That's such a worry something","Therapist: ""All right.  So what do you think is causing this worry  about being gone more than two days?""
Patient: ""I don't know.  always, as a late teenager in my 20s, I've always had just nervous to leave home. I don't,  as much as I love being home, I love to travel too and, you know, do different things. It's  just, I guess I'm just afraid something will happen when I'm not around.""
Therapist: ""Alright, so you're afraid something will happen to your house or?""",162.12,175.9
023_027,023,27,2,"Like you could come back. Yeah. Like I'm ready to come back but then I'm missing.  Because I'm like, man, I really don't want to go back to that home. Like I want to come back to my family  and everything's okay but I miss, you know, where I just left because it's away  from home. I know it sounds really conflicting and weird but you know I'd  like to get away. I enjoy being away from this small town so.","Therapist: ""Alright, so you're afraid something will happen to your house or?""
Patient: ""Well, I have pets so I worry about them. My parents are getting older so I worry about  them. Mainly like my immediate family. Mainly I guess my dad because he's had a  history of heart attacks and then my pets. That's such a worry something""
Therapist: ""happened I won't be there. And how about when you were younger you said this  problem's been around for a while. It's the same thing. The same thing. So mostly family and  now some pets. I had pets then too. Yeah pets then too. Okay. So that's really  That's really what's bothering me here is that you'll be away and that's when  something will happen. And it'll be something bad. What about coming back?""",204.82,228.32
023_031,023,31,3,Yeah.,"Therapist: ""Yes you have feelings that are, they're fighting one another.""
Patient: ""Absolutely.""
Therapist: ""And right now the feeling, the thought anyway of you know I would like to go on  the trip is winning but the fear thought is kind of dragging, dragging you down.""",243.72,245.72
023_033,023,33,2,"Yeah, I get anxious. My heart feels like it's heavy, my chest feels heavy.  All these thoughts go through my mind. I know my parents,  somebody could watch my pets, but they may not take care of them like I would. I don't know.  They'll take care of them, I know, but they'll miss me.  miss me and they might tear my house up. I don't know. All these thoughts go through my mind that","Therapist: ""And right now the feeling, the thought anyway of you know I would like to go on  the trip is winning but the fear thought is kind of dragging, dragging you down.""
Patient: ""Yeah.""
Therapist: ""So what's the sensation? Anxiety?""",250.72,274.2
023_037,023,37,2,"Um, no.  No.  Nothing happened?  Uh huh.","Therapist: ""seem crazy to me. So it seems like an endless stream of worries. Yeah. Surrounding family and  the pets and what might happen. So really that's it, right? That's, it's what might happen. It's  That's the uncertainty.""
Patient: ""Right.""
Therapist: ""Yeah.  So has anything ever happened?""",292.24,296.24
023_042,023,42,2,"And now that I'm older.  When I was younger, I probably wouldn't, like an overnight.  But now that I'm older, yes, I do.  I just say, I gotta live my life and it'll be okay.  I just try to tell myself, they're in good hands.  If something happens, somebody will call me.  But then I feel like, oh, but I'm gonna be hours away.  I'm a plane ride away.  And then I get thinking about that, but I do go.","Patient: ""No.""
Therapist: ""Do you end up going on the trips anyway?""
Unknown: ""Yes.""",310.24,332.2
023_044,023,44,2,"No.  So something changed, what changed?  I don't know.  I really, I don't know.  I don't know what made a difference.  Maybe I just feel more, I don't know, I want to say in control, but now that I'm living  on my own, because that's when I wouldn't go is when I lived at home with my parents  still, which seems weird because somebody was always there to look after my animals.  But now that I'm living on my own, maybe I just feel more responsible that I have to  go do these things.  I really don't know what changed.","Unknown: ""Yes.""
Patient: ""And now that I'm older.  When I was younger, I probably wouldn't, like an overnight.  But now that I'm older, yes, I do.  I just say, I gotta live my life and it'll be okay.  I just try to tell myself, they're in good hands.  If something happens, somebody will call me.  But then I feel like, oh, but I'm gonna be hours away.  I'm a plane ride away.  And then I get thinking about that, but I do go.""
Therapist: ""But you didn't in the past.""",333.5,368.92
023_046,023,46,2,"Not too much.  Once I get there, I'm usually okay.  Maybe the first night I get a little worried, and then maybe when I'm getting ready to come  home I'm like a little anxious.  I'm ready to get home to make sure everything's okay.","Therapist: ""But you didn't in the past.""
Patient: ""No.  So something changed, what changed?  I don't know.  I really, I don't know.  I don't know what made a difference.  Maybe I just feel more, I don't know, I want to say in control, but now that I'm living  on my own, because that's when I wouldn't go is when I lived at home with my parents  still, which seems weird because somebody was always there to look after my animals.  But now that I'm living on my own, maybe I just feel more responsible that I have to  go do these things.  I really don't know what changed.""
Therapist: ""So you're not sure it changed, but you used to not go, now you do go.  So when you're down there, or wherever you're going, the trip, you're feeling better?  Like you're enjoying yourself, but you're also worried at the same time?""",382.88,394.04
023_048,023,48,1,"I'm usually okay.  I want to get some alcohol involved, so it kind of limits my anxiety.  But once I get into playing the golf and all that, I really do allow myself to enjoy it.  It's just, it seems like it's going and coming.","Therapist: ""So you're not sure it changed, but you used to not go, now you do go.  So when you're down there, or wherever you're going, the trip, you're feeling better?  Like you're enjoying yourself, but you're also worried at the same time?""
Patient: ""Not too much.  Once I get there, I'm usually okay.  Maybe the first night I get a little worried, and then maybe when I'm getting ready to come  home I'm like a little anxious.  I'm ready to get home to make sure everything's okay.""
Therapist: ""And the rest of the time?""",395.04,409.08
023_052,023,52,2,"It's like a plane.  have a problem riding, like flying out, but it's the thinking, like while I'm waiting for the plane,  like, well what if we, what if a terrorist is on there, what if we crash? I'll think about all that  before, but once I'm there and on the plane, it's like, right, take off, I'm fine, I'm completely  fine, I'm not anxious. It's leading up to the actual event that makes me anxious.","Therapist: ""Alright, so the problem really isn't when you're there.  It's leading up to.  The problem is now.""
Patient: ""Yes.""
Therapist: ""Leading up to, right?  Exactly.  Yes.  And maybe just the first half day or day when you're there.  Or maybe the last half day or day you're there.""",426.1,445.64
023_054,023,54,4,"changed my mind probably a dozen times before I actually say yes I'm going. And when you do go,","Therapist: ""Leading up to, right?  Exactly.  Yes.  And maybe just the first half day or day when you're there.  Or maybe the last half day or day you're there.""
Patient: ""It's like a plane.  have a problem riding, like flying out, but it's the thinking, like while I'm waiting for the plane,  like, well what if we, what if a terrorist is on there, what if we crash? I'll think about all that  before, but once I'm there and on the plane, it's like, right, take off, I'm fine, I'm completely  fine, I'm not anxious. It's leading up to the actual event that makes me anxious.""
Therapist: ""Alright, so it's anticipation. So that's, that's the worst part. So the period between now and when  you leave it's gonna be the worst part. Yes. But you'll probably still go. Probably, but I'll have""",460.42,466.52
023_056,023,56,4,"I don't know. I try not to think that far. If I get thinking about it, I try to like shut it out. I don't want to think about the worst.  the worst I'll get on a plane and come home and I'll deal with it then but...","Therapist: ""Alright, so it's anticipation. So that's, that's the worst part. So the period between now and when  you leave it's gonna be the worst part. Yes. But you'll probably still go. Probably, but I'll have""
Patient: ""changed my mind probably a dozen times before I actually say yes I'm going. And when you do go,""
Therapist: ""you'll have a good time. Mm-hmm. And the probability of something happening that you're worried about  based on the history seems low. Yeah. Something could happen certainly. Sure. But it hasn't so far.  Alright, so there's a few angles here. So what happens if you go down there and a bad scenario or worst case scenario does happen?""",493.62,512.46
023_058,023,58,4,Mm-hmm.,"Therapist: ""you'll have a good time. Mm-hmm. And the probability of something happening that you're worried about  based on the history seems low. Yeah. Something could happen certainly. Sure. But it hasn't so far.  Alright, so there's a few angles here. So what happens if you go down there and a bad scenario or worst case scenario does happen?""
Patient: ""I don't know. I try not to think that far. If I get thinking about it, I try to like shut it out. I don't want to think about the worst.  the worst I'll get on a plane and come home and I'll deal with it then but...""
Therapist: ""Alright, so you'll return?""",514.66,516.66
023_062,023,62,2,Yeah.  But it still doesn't stop me from worrying when I get these trips planned.,"Therapist: ""And the best case scenario would be you enjoy yourself.""
Unknown: ""Yeah.""
Therapist: ""Which is the more likely, historically that's the more likely scenario.""",526.86,532.38
023_069,023,69,1,Like I've got to get my house cleaned up and make sure my animals have enough food.  Like preparing to leave.,"Patient: ""Mm-hmm.""
Unknown: ""Yeah.""
Therapist: ""So what are you thinking when you're thinking about the trip now?  If you were to think about getting ready to go on this trip, what would go through your mind?  What specific thoughts?""",570.18,579.12
023_071,023,71,4,"Probably like, I want to say, I don't know, I really, it's kind of hard.  Like I want to, like I can't say bye enough to my parents or I can't say bye enough to  my pets.  Like I feel like I, like I don't know.  I really, that's I guess part of the problem.  I don't know what I'm connecting it to.  I just get really anxious.","Therapist: ""So what are you thinking when you're thinking about the trip now?  If you were to think about getting ready to go on this trip, what would go through your mind?  What specific thoughts?""
Patient: ""Like I've got to get my house cleaned up and make sure my animals have enough food.  Like preparing to leave.""
Therapist: ""Preparing is productive.  Right.  That makes sense.  Yeah.  How about the thoughts that you feel are more connected to the warning?""",588.7,614.84
023_073,023,73,4,"Yeah, I don't know, maybe... I don't know, it sounds so...","Therapist: ""Preparing is productive.  Right.  That makes sense.  Yeah.  How about the thoughts that you feel are more connected to the warning?""
Patient: ""Probably like, I want to say, I don't know, I really, it's kind of hard.  Like I want to, like I can't say bye enough to my parents or I can't say bye enough to  my pets.  Like I feel like I, like I don't know.  I really, that's I guess part of the problem.  I don't know what I'm connecting it to.  I just get really anxious.""
Therapist: ""So if you don't tell them goodbye enough times...""",617.84,621.84
023_077,023,77,2,Maybe. I don't know. I just know that's what I think about when...  That's one thing that first comes to my mind when you ask me to connect the thoughts to the worry and I think about telling everybody bye.,"Therapist: ""Well, it sounds like maybe if you don't say... if you don't say goodbye enough times and settle that, that you'll feel guilty if something happens.""
Patient: ""Maybe.""
Therapist: ""Like you'll regret it?""",634.84,645.84
023_079,023,79,2,Like letting go for a few days. Yeah.,"Therapist: ""Like you'll regret it?""
Patient: ""Maybe. I don't know. I just know that's what I think about when...  That's one thing that first comes to my mind when you ask me to connect the thoughts to the worry and I think about telling everybody bye.""
Therapist: ""So that's a focal point of this anxiety in some way, right? The process.""",651.84,655.84
023_081,023,81,3,finally say bye I'll talk to you later love you you know I'll check in when I  land or whatever and then that's it then it's like I just have to try to breathe  and just put those thoughts behind me because once I say it it's like okay,"Therapist: ""So that's a focal point of this anxiety in some way, right? The process.""
Patient: ""Like letting go for a few days. Yeah.""
Therapist: ""And the way you start to let go is when you tell them goodbye.  Yeah.  So what do you find yourself doing? Do you say goodbye and then leave and then come back or call them up?""",666.84,681.84
023_083,023,83,4,"I don't know. I just... no, that doesn't come to my mind.","Therapist: ""And the way you start to let go is when you tell them goodbye.  Yeah.  So what do you find yourself doing? Do you say goodbye and then leave and then come back or call them up?""
Patient: ""finally say bye I'll talk to you later love you you know I'll check in when I  land or whatever and then that's it then it's like I just have to try to breathe  and just put those thoughts behind me because once I say it it's like okay""
Therapist: ""that's it I'm gone but your but your thoughts are still coming the thoughts  are still coming and say you should have said goodbye one more time no it's not""",691.38,695.14
023_087,023,87,2,"Maybe it's just the fact that I'm leaving.  And I shouldn't leave.  Alright.  Maybe. Not that I would say that.  Yeah, maybe I feel like I... maybe it's just the guilt of leaving.","Therapist: ""That you didn't say goodbye well enough?""
Patient: ""I don't know.""
Therapist: ""Yeah, I'm trying to think, what's the property of...  What's the property of saying goodbye that you feel like you're not doing well enough?""",704.46,716.66
023_089,023,89,2,Not being there if something happens.,"Therapist: ""Yeah, I'm trying to think, what's the property of...  What's the property of saying goodbye that you feel like you're not doing well enough?""
Patient: ""Maybe it's just the fact that I'm leaving.  And I shouldn't leave.  Alright.  Maybe. Not that I would say that.  Yeah, maybe I feel like I... maybe it's just the guilt of leaving.""
Therapist: ""So the act of leaving itself leaves you guilty.  And what are you guilty of?""",725.06,727.06
023_093,023,93,2,"Probably, maybe I did feel a little guilty.","Therapist: ""So abandoning them?""
Patient: ""Maybe.""
Therapist: ""For a short time, neglecting them for a short time.  Is that what it felt like when you were younger?  When you weren't able to travel,  it did stop you? The anxiety did stop you?""",751.46,755.86
023_095,023,95,1,"Maybe a little bit. I mean I've always been, I'm the youngest of my,  me and my sister, but my parents have always looked up to me to be the responsible one  and make sure everything's taken care of.  So I probably kind of allowed myself to take on that role of the caregiver more so  or be the more responsible one of the two.","Therapist: ""For a short time, neglecting them for a short time.  Is that what it felt like when you were younger?  When you weren't able to travel,  it did stop you? The anxiety did stop you?""
Patient: ""Probably, maybe I did feel a little guilty.""
Therapist: ""And now you're in,  would you say, more of a caregiver role than you were then?""",767.06,784.78
023_097,023,97,4,"I guess. Maybe I should stay home and be responsible.  And they don't make me feel guilty.  They say, go have a good time.  Your baby's going to be okay. We'll take care of him.  I mean, I know they're in good hands. That's what makes it so difficult.  I know they'll be okay, but I just feel like I probably shouldn't go.","Therapist: ""And now you're in,  would you say, more of a caregiver role than you were then?""
Patient: ""Maybe a little bit. I mean I've always been, I'm the youngest of my,  me and my sister, but my parents have always looked up to me to be the responsible one  and make sure everything's taken care of.  So I probably kind of allowed myself to take on that role of the caregiver more so  or be the more responsible one of the two.""
Therapist: ""So to be the responsible one, there needs to be guilt when you leave.""",791.44,809.36
023_103,023,103,4,I wasn't there to fix it or take care of it or make it better.  I put it on somebody else to have to deal with that.,"Therapist: ""It's coming in from inside.""
Patient: ""Yeah.""
Therapist: ""So if I leave, well, I'm responsible.  And if I leave, something bad will happen, and that will be on me.""",830.08,835.9
023_105,023,105,2,"Maybe, yeah.  If something happened to my pets, then my parents,  I know they'll take care of them, but they would have to be the one doing that.  I wouldn't be there for them.  And I'd want to be there.  If something happened to my dad, it'd be on my mom and I'd want to be there  the help and support and you know do what I can.","Therapist: ""So if I leave, well, I'm responsible.  And if I leave, something bad will happen, and that will be on me.""
Patient: ""I wasn't there to fix it or take care of it or make it better.  I put it on somebody else to have to deal with that.""
Therapist: ""So fear of being caught is irresponsible?""",842.76,863.58
023_107,023,107,2,"Not really. No, because it's like I want immediate access.  Like I want to be able to be right there within minutes if they need me.","Therapist: ""So fear of being caught is irresponsible?""
Patient: ""Maybe, yeah.  If something happened to my pets, then my parents,  I know they'll take care of them, but they would have to be the one doing that.  I wouldn't be there for them.  And I'd want to be there.  If something happened to my dad, it'd be on my mom and I'd want to be there  the help and support and you know do what I can.""
Therapist: ""And you could be if you left it would just take you a day's travel or whatever however far away you went.  Yeah.  But that's still doesn't help relieve your anxiety.  No, not really.  Now when you can come back it doesn't help.""",876.58,882.58
023_111,023,111,4,"I mean, it's not as bad, but yeah, if I go stay with a friend for like an overnight,  on the way up sometimes I'm thinking I should just stay home.  Or I could be right in the same town sometimes that if I wake up at 5 in the morning,  I just get up and go home because I just I just get really start feeling really anxious and I'm ready home","Therapist: ""Have you ever taken a trip that was within less than four hours driving distance or something?  That's overnight?  Does that cause the same anxiety?""
Patient: ""It does.""
Therapist: ""But you can get back fairly quickly.""",895.58,914.64
023_113,023,113,1,"In the way that you view it when I work 20-hour shifts, and I have to work the overnight  I will most of the time take my break and go home in between the check on the house  feed my pets and yeah.","Therapist: ""But you can get back fairly quickly.""
Patient: ""I mean, it's not as bad, but yeah, if I go stay with a friend for like an overnight,  on the way up sometimes I'm thinking I should just stay home.  Or I could be right in the same town sometimes that if I wake up at 5 in the morning,  I just get up and go home because I just I just get really start feeling really anxious and I'm ready home""
Therapist: ""So the closer you are it helps a little but it sounds like a good part of anxiety still there  So it really doesn't matter where you go  It's that the fact that you're not home the fact that you're not able to fully be responsible""",929.54,942.12
023_115,023,115,2,"Probably usually like six, seven hours into it just depends.  Like now it's getting dark.  So when it kind of gets dark,  if I don't leave the light on or something,  I get a little anxious.  I feel like I need to go home and leave the light on  and you know, just let my pets know I'm coming back.  It's weird, but I know they miss me.  But if I'm busy, then I don't really think about it.  So if I'm busy at work doing something,  I don't really think about it until I stop what I'm doing  or I slow down and I'm thinking,  well, I got 10 more hours or eight more hours.  Sometimes I go home, sometimes I don't.  Sometimes it's worse than others.","Therapist: ""So the closer you are it helps a little but it sounds like a good part of anxiety still there  So it really doesn't matter where you go  It's that the fact that you're not home the fact that you're not able to fully be responsible""
Patient: ""In the way that you view it when I work 20-hour shifts, and I have to work the overnight  I will most of the time take my break and go home in between the check on the house  feed my pets and yeah.""
Therapist: ""So at 20, that's a long shift.  So a 20 hour shift, at what point do you become anxious?  When do you start to notice those thoughts and feelings?""",954.42,986.32
023_117,023,117,1,"Maybe because I know I'm close, I can get there.  I know I'm in control, I'll be able to go there.  To a degree.","Therapist: ""So at 20, that's a long shift.  So a 20 hour shift, at what point do you become anxious?  When do you start to notice those thoughts and feelings?""
Patient: ""Probably usually like six, seven hours into it just depends.  Like now it's getting dark.  So when it kind of gets dark,  if I don't leave the light on or something,  I get a little anxious.  I feel like I need to go home and leave the light on  and you know, just let my pets know I'm coming back.  It's weird, but I know they miss me.  But if I'm busy, then I don't really think about it.  So if I'm busy at work doing something,  I don't really think about it until I stop what I'm doing  or I slow down and I'm thinking,  well, I got 10 more hours or eight more hours.  Sometimes I go home, sometimes I don't.  Sometimes it's worse than others.""
Therapist: ""All right.  So if you're busy at work,  the same reality exists, meaning your pets are alone.  But the way you're responding to it is different.  You're less anxious.""",1001.44,1007.5
023_123,023,123,2,"No, not yet.","Therapist: ""But the same reality exists.  They're alone.  So really it's your way of, it's your way of viewing things that's leading to your anxiety.  It's not necessarily what's actually happening.  That's my perception.  It's your perception of what's happening or could happen, I guess in this case.  Not so much what is happening as what you worry could happen.""
Patient: ""Could, yeah, definitely.""
Therapist: ""Yeah, because nothing's happened yet.""",1048.5,1051.5
023_125,023,125,2,"I don't really take long vacations.  I've taken only, I'm trying to think, I've only taken like two week long vacations ever.  For like five, six days and I was fine.  Well, same anxiety.  When I was younger and now it's more like long weekends or you know, a night here or  I don't really take long vacations, but probably maybe three or four times a year  I might go away overnight versus just not just a friend's house like an actual vacation where I go into a city or something","Therapist: ""Yeah, because nothing's happened yet.""
Patient: ""No, not yet.""
Therapist: ""Yeah.  So how many, well I guess there's a few different issues here, right?  How many vacations do you take a year?""",1066.26,1092.92
023_127,023,127,4,Yeah.,"Therapist: ""Yeah.  So how many, well I guess there's a few different issues here, right?  How many vacations do you take a year?""
Patient: ""I don't really take long vacations.  I've taken only, I'm trying to think, I've only taken like two week long vacations ever.  For like five, six days and I was fine.  Well, same anxiety.  When I was younger and now it's more like long weekends or you know, a night here or  I don't really take long vacations, but probably maybe three or four times a year  I might go away overnight versus just not just a friend's house like an actual vacation where I go into a city or something""
Therapist: ""So a small proportion of the time  So just looking in terms of probabilities  Your risk is very low  Because you're not caught that much, but the other issue is that even at work  You're still having these same feelings and even for short trips  You're still having the same feelings  So you're really living with anxiety much of the time?""",1117.16,1120.16
023_129,023,129,3,"Yeah, probably since a teenager.  I mean, it hasn't stopped me. I've always worked. I mean, now I work more than ever.  It doesn't stop me from working, picking up overtime, working three jobs.  It doesn't stop me.  Like I said, as a teenager, early 20s it did. I would just be like on my way out somewhere,  to go stay the night with my boyfriend. I was like, no, I can't do it. And I turn around and come home.  But now that doesn't happen. It may not, I may not go for a week-long vacation, but I'll go for a few nights.","Therapist: ""So a small proportion of the time  So just looking in terms of probabilities  Your risk is very low  Because you're not caught that much, but the other issue is that even at work  You're still having these same feelings and even for short trips  You're still having the same feelings  So you're really living with anxiety much of the time?""
Patient: ""Yeah.""
Therapist: ""And it's been this way for years?""",1122.16,1153.16
023_133,023,133,2,"Yeah, I mean, it doesn't, like I said, it doesn't really seem to stop me from working, obviously, because I work.  It's just that it's leading up to leaving for work or going on vacation.","Therapist: ""So your functioning has improved. It's actually pretty good. You're working a lot, it sounds like.""
Patient: ""Yeah.""
Therapist: ""But it's this uncomfortable anxiety that's painful for you.""",1169.6,1179.38
023_135,023,135,1,"Well, I'm thinking about making sure I have everything I need for work.  You know, do I have, I usually take my dinner.  I may have to do it when I get to work, you know, check emails or give, you know, do whatever I have to do.  And then I just make sure, you know,  my animals are taken care of. I make sure they got food and water and the house is cleaned out, everything's put away, you know.  Stove's turned off. It sounds silly, but you know, stuff that they can't get into.  That's why I just make sure all that's taken care of the best I can.  Like I'm trying to prevent something that might happen. If I see something out like a, I don't know, if I have flowers sitting around,  around make sure they're put away because the cats get into them so I just  try to prevent anything I can from happening or could happen do you feel","Therapist: ""But it's this uncomfortable anxiety that's painful for you.""
Patient: ""Yeah, I mean, it doesn't, like I said, it doesn't really seem to stop me from working, obviously, because I work.  It's just that it's leading up to leaving for work or going on vacation.""
Therapist: ""All right.  So let's say, let's look at what you know is going to be a long work day.  So think of like, what, is that a 20-hour shift?  It's a lot of time.  So, you have a 20 hour shift and say you're getting ready for work and you're thinking  about that you're going to be gone for 20 hours.  You do think about that, I imagine, right?  You have to probably make certain plans to be gone that long.  What's going through your mind as you're getting ready for work?""",1208.6,1258.6
023_137,023,137,2,"Just, I gotta go to work and I just think about, I'll come home later, you know, if I get a  break. I mean, usually I do, especially if I do the overnight, I got down time, so  I'll run home and check on them. And then I'm off to work and then I kind of forget about it.  And like I said, some nights it's better than not every night I come home and check on them.  But some nights I just get started and feel anxious and get thinking about them and I go home and check on them.","Therapist: ""All right.  So let's say, let's look at what you know is going to be a long work day.  So think of like, what, is that a 20-hour shift?  It's a lot of time.  So, you have a 20 hour shift and say you're getting ready for work and you're thinking  about that you're going to be gone for 20 hours.  You do think about that, I imagine, right?  You have to probably make certain plans to be gone that long.  What's going through your mind as you're getting ready for work?""
Patient: ""Well, I'm thinking about making sure I have everything I need for work.  You know, do I have, I usually take my dinner.  I may have to do it when I get to work, you know, check emails or give, you know, do whatever I have to do.  And then I just make sure, you know,  my animals are taken care of. I make sure they got food and water and the house is cleaned out, everything's put away, you know.  Stove's turned off. It sounds silly, but you know, stuff that they can't get into.  That's why I just make sure all that's taken care of the best I can.  Like I'm trying to prevent something that might happen. If I see something out like a, I don't know, if I have flowers sitting around,  around make sure they're put away because the cats get into them so I just  try to prevent anything I can from happening or could happen do you feel""
Therapist: ""less anxious when you put those prevention okay so that helps so  physically preparing your house so that your pets are safer that helps you all  right so what else is going through your mind so you do that right so you take  all the precautions you can to keep them safe and prepare your dinner for work  and everything. So what's the next thought?""",1286.58,1312.38
023_139,023,139,4,"Oh yeah. If I'm out, you know, working with clients, yeah.","Therapist: ""less anxious when you put those prevention okay so that helps so  physically preparing your house so that your pets are safer that helps you all  right so what else is going through your mind so you do that right so you take  all the precautions you can to keep them safe and prepare your dinner for work  and everything. So what's the next thought?""
Patient: ""Just, I gotta go to work and I just think about, I'll come home later, you know, if I get a  break. I mean, usually I do, especially if I do the overnight, I got down time, so  I'll run home and check on them. And then I'm off to work and then I kind of forget about it.  And like I said, some nights it's better than not every night I come home and check on them.  But some nights I just get started and feel anxious and get thinking about them and I go home and check on them.""
Therapist: ""So every bit of time when you felt anxious and you wanted to check on them but you couldn't leave work?""",1316.38,1321.38
023_141,023,141,1,"I don't dwell on it because my focus is with the clients.  So I just kind of think about it, I need to get home, but you know, and I just focus back on the client.  I don't let it overwhelm me or...","Therapist: ""So every bit of time when you felt anxious and you wanted to check on them but you couldn't leave work?""
Patient: ""Oh yeah. If I'm out, you know, working with clients, yeah.""
Therapist: ""So what happens then in terms of thinking and feeling?""",1325.38,1335.38
023_143,023,143,1,"It goes away. I mean, when I'm thinking about it, but then it goes away.","Therapist: ""So what happens then in terms of thinking and feeling?""
Patient: ""I don't dwell on it because my focus is with the clients.  So I just kind of think about it, I need to get home, but you know, and I just focus back on the client.  I don't let it overwhelm me or...""
Therapist: ""Well, so it doesn't change your functioning.  Not at all.  But how about the anxiety? Is there anxiety associated with it?""",1340.38,1343.38
023_145,023,145,1,Or got into something or yeah.,"Therapist: ""Well, so it doesn't change your functioning.  Not at all.  But how about the anxiety? Is there anxiety associated with it?""
Patient: ""It goes away. I mean, when I'm thinking about it, but then it goes away.""
Therapist: ""Alright, so depending on what you're thinking about, that can change the level of anxiety you're experiencing.  Alright. So we talked about how cognitive therapy works before in other sessions, right?  And of course thinking, we believe, is an important component of it.  You can change the way you feel and what you do, behavior, through thinking.  So at some point, like in your work day, you're having a thought, I'm going to guess, you're  having a thought that says that I need to get back there and check on them.  Or something like that.  Or they might not be okay.""",1385.5,1388.8
023_147,023,147,2,"I have an older cat.  I mean, he's really old.  So I think, well, you know, what if, you know,  he's something's happened to him.  I mean, I don't necessarily think of him dying,  but I think, you know, what if he needs me?  Because he is, he's really old.  So I do think about him.","Therapist: ""Alright, so depending on what you're thinking about, that can change the level of anxiety you're experiencing.  Alright. So we talked about how cognitive therapy works before in other sessions, right?  And of course thinking, we believe, is an important component of it.  You can change the way you feel and what you do, behavior, through thinking.  So at some point, like in your work day, you're having a thought, I'm going to guess, you're  having a thought that says that I need to get back there and check on them.  Or something like that.  Or they might not be okay.""
Patient: ""Or got into something or yeah.""
Therapist: ""Okay, so that is the thought you're having,  something like that.""",1392.48,1404.32
023_149,023,149,1,stop right and it just comes naturally when I'm getting ready to leave and then,"Therapist: ""Okay, so that is the thought you're having,  something like that.""
Patient: ""I have an older cat.  I mean, he's really old.  So I think, well, you know, what if, you know,  he's something's happened to him.  I mean, I don't necessarily think of him dying,  but I think, you know, what if he needs me?  Because he is, he's really old.  So I do think about him.""
Therapist: ""I see you have that thought,  like you have a cat that's advanced in age,  something could happen.  The cats could have gotten into stuff.  and that anxiety will either persist and you'll act on it by driving home or you'll become  distracted by it, it demands your work and the anxiety will go away.  So you can see the power of thinking in all this, right? So the reality of your cat's  health and well-being hasn't changed.  The way you view it has changed, the way you think about it has changed.  So we talked about before this idea of the adaptive response.  So the thoughts you're having now that lead to the anxiety,  what we believe could lead to the anxiety, they're automatic, right?  They're just popping in your head.  They're triggered by certain things like getting ready to leave for work  and being at work a while and kind of looking at the time  and realizing something we have for the cats, right?  right but that's an automatic that just comes without but you can't necessarily""",1474.62,1479.3
023_151,023,151,4,So I'm disputing my own thoughts.,"Therapist: ""I see you have that thought,  like you have a cat that's advanced in age,  something could happen.  The cats could have gotten into stuff.  and that anxiety will either persist and you'll act on it by driving home or you'll become  distracted by it, it demands your work and the anxiety will go away.  So you can see the power of thinking in all this, right? So the reality of your cat's  health and well-being hasn't changed.  The way you view it has changed, the way you think about it has changed.  So we talked about before this idea of the adaptive response.  So the thoughts you're having now that lead to the anxiety,  what we believe could lead to the anxiety, they're automatic, right?  They're just popping in your head.  They're triggered by certain things like getting ready to leave for work  and being at work a while and kind of looking at the time  and realizing something we have for the cats, right?  right but that's an automatic that just comes without but you can't necessarily""
Patient: ""stop right and it just comes naturally when I'm getting ready to leave and then""
Therapist: ""the anxieties right there so the adaptive response we also call self-talk  that's that's a thought that you can give that you can create consciously  right that you can think to yourself so it's not automatic it's not an  adjustment of an automatic thought. It's a thought that you can deliberately think.  Almost like repeating a sentence that you've memorized. You can at will choose  to do that. Does that make sense? So I want to make sure I draw the distinction. Some  thoughts just pop in, other thoughts you deliberately think. What we've found is  if you have a thought that you deliberately think, we call the adaptive  response, it can counter the feelings caused by the automatic thoughts.  Essentially, you're challenging, you're disputing that automatic thought.""",1534.78,1536.78
023_153,023,153,1,"Well, I do tell them that.  I tell them, like, when I feel like they're,  well, sometimes they'll run from me  when I try to kiss them goodbye.  And I'm like, oh no, but I have to go to work  because you all have to eat.  I know it sounds silly, but I do tell them that.  And then that kind of makes, it does lessen anxiety.  I didn't realize that's kind of what I was doing,  but I do do that sometimes.","Therapist: ""the anxieties right there so the adaptive response we also call self-talk  that's that's a thought that you can give that you can create consciously  right that you can think to yourself so it's not automatic it's not an  adjustment of an automatic thought. It's a thought that you can deliberately think.  Almost like repeating a sentence that you've memorized. You can at will choose  to do that. Does that make sense? So I want to make sure I draw the distinction. Some  thoughts just pop in, other thoughts you deliberately think. What we've found is  if you have a thought that you deliberately think, we call the adaptive  response, it can counter the feelings caused by the automatic thoughts.  Essentially, you're challenging, you're disputing that automatic thought.""
Patient: ""So I'm disputing my own thoughts.""
Therapist: ""You're disputing your own thoughts.  Yeah.  So, and I want you to work with me to develop these adaptive responses.  I want you to have most of the say, all the say if you want in them, because I think that  that you can develop ones that are useful to you. But just to give an example, when  you have a thought that, you know, the older cat could be sick, right? An adaptive  response could be, well, could be a wide variety of thoughts, but one could be  it's not likely right like you know or if it is likely that you know he'll  probably be okay now if it's a he or she he okay he'll probably be okay till I  get home another adaptive response could be it would be sad and unfortunate  something happened but I have my work responsibilities and at some point I  have to leave the cats alone.""",1604.0,1622.04
023_155,023,155,2,"Yeah, but I didn't realize that's what I was doing.  But yeah, I do say that to myself, well, to them, yeah.","Therapist: ""You're disputing your own thoughts.  Yeah.  So, and I want you to work with me to develop these adaptive responses.  I want you to have most of the say, all the say if you want in them, because I think that  that you can develop ones that are useful to you. But just to give an example, when  you have a thought that, you know, the older cat could be sick, right? An adaptive  response could be, well, could be a wide variety of thoughts, but one could be  it's not likely right like you know or if it is likely that you know he'll  probably be okay now if it's a he or she he okay he'll probably be okay till I  get home another adaptive response could be it would be sad and unfortunate  something happened but I have my work responsibilities and at some point I  have to leave the cats alone.""
Patient: ""Well, I do tell them that.  I tell them, like, when I feel like they're,  well, sometimes they'll run from me  when I try to kiss them goodbye.  And I'm like, oh no, but I have to go to work  because you all have to eat.  I know it sounds silly, but I do tell them that.  And then that kind of makes, it does lessen anxiety.  I didn't realize that's kind of what I was doing,  but I do do that sometimes.""
Therapist: ""So you were already adaptively responding.""",1624.18,1629.86
023_157,023,157,2,so.  Yeah.  That's true.  Never thought of it that way.,"Therapist: ""So you were already adaptively responding.""
Patient: ""Yeah, but I didn't realize that's what I was doing.  But yeah, I do say that to myself, well, to them, yeah.""
Therapist: ""Well I think that's a productive adaptive response.  Right?  I mean you're right.  You're right.  If you don't earn an income then they'll have worse problems.  Yeah.  I can't take care of them.  Than being left alone.  Right?  So really, through working, you're being more of a service to them and protecting them more""",1649.7,1654.98
023_159,023,159,2,"And then there's times I think, you know, they're just cats, they're probably glad I'm","Therapist: ""Well I think that's a productive adaptive response.  Right?  I mean you're right.  You're right.  If you don't earn an income then they'll have worse problems.  Yeah.  I can't take care of them.  Than being left alone.  Right?  So really, through working, you're being more of a service to them and protecting them more""
Patient: ""so.  Yeah.  That's true.  Never thought of it that way.""
Therapist: ""So that might be one adaptive response you may want to consider applying when you have  this feeling of anxiety.""",1664.06,1668.06
023_161,023,161,2,"They're probably happy because sometimes they're sleeping when I get home and I'm worried.  I look and they're like literally waking up looking at me like, whoa, you're home, we  were sleeping.  So they're probably like glad I'm gone anyway.","Therapist: ""So that might be one adaptive response you may want to consider applying when you have  this feeling of anxiety.""
Patient: ""And then there's times I think, you know, they're just cats, they're probably glad I'm""
Unknown: ""gone.""",1669.06,1680.78
023_163,023,163,1,"Sometimes. Sometimes after the 20-hour shift, yes, I have one of them. She won't let me sleep the first hour.  She literally will run around and get into stuff. And I take it that she's mad because I've been gone, but she's fine.","Unknown: ""gone.""
Patient: ""They're probably happy because sometimes they're sleeping when I get home and I'm worried.  I look and they're like literally waking up looking at me like, whoa, you're home, we  were sleeping.  So they're probably like glad I'm gone anyway.""
Therapist: ""So they're not striking you as anxious when you get home, right?""",1683.98,1696.48
023_165,023,165,1,"Yeah, that's true.","Therapist: ""So they're not striking you as anxious when you get home, right?""
Patient: ""Sometimes. Sometimes after the 20-hour shift, yes, I have one of them. She won't let me sleep the first hour.  She literally will run around and get into stuff. And I take it that she's mad because I've been gone, but she's fine.""
Therapist: ""She continues to survive despite being perhaps upset with you for leaving.  Yes.  So that could be another adaptive response that they may be enduring a mild stressor, but sometimes they're asleep when you get home.""",1713.48,1715.48
023_167,023,167,2,Yeah. And they don't know I'm worrying or anxious. They could care less.  They don't really know. It's not bothering them.,"Therapist: ""She continues to survive despite being perhaps upset with you for leaving.  Yes.  So that could be another adaptive response that they may be enduring a mild stressor, but sometimes they're asleep when you get home.""
Patient: ""Yeah, that's true.""
Therapist: ""How bad could it be for them?""",1718.48,1726.48
023_169,023,169,1,"That's just me. I'm an animal person but I think they do. But yeah I'd probably give  them, I think they have more feelings than what they probably really do. But they're my kids.  I treat them as kids. They're my kids. They're all God. Sure. They're important to you.","Therapist: ""How bad could it be for them?""
Patient: ""Yeah. And they don't know I'm worrying or anxious. They could care less.  They don't really know. It's not bothering them.""
Therapist: ""Yeah, I mean their level of awareness is clearly different than yours, right?  So yeah, I mean that's another good adaptive response that you have a much higher level of awareness  whereas you're not sure they have any awareness that they're experiencing  anxiety or maybe a little bit with the one cat who runs around. I think they do.""",1746.86,1759.32
023_171,023,171,1,"That does.  Because like I said, I had to kind of  said those things to myself anyway.  I just didn't realize that's what  was probably lessening the anxiety.  Because I do say those things to myself pretty frequently  when I say I have to go to work  or else you guys won't be able to be taken care of.  Didn't even dawn on me that that's...","Therapist: ""Yeah, I mean their level of awareness is clearly different than yours, right?  So yeah, I mean that's another good adaptive response that you have a much higher level of awareness  whereas you're not sure they have any awareness that they're experiencing  anxiety or maybe a little bit with the one cat who runs around. I think they do.""
Patient: ""That's just me. I'm an animal person but I think they do. But yeah I'd probably give  them, I think they have more feelings than what they probably really do. But they're my kids.  I treat them as kids. They're my kids. They're all God. Sure. They're important to you.""
Therapist: ""Yeah, absolutely. So it's understandable that you would be anxious and have  concerns and but it also seems like you do make preparations to elevate their  chances of having a successful experience right being okay yeah so you  you implement behaviors that are practical and that have worked right  making the house safe and keeping the plants away from them so I think one  One route here, if you're okay with it, would be to use work as kind of like the first point.  I know you have the trip, I know that appears to be causing more anxiety than going to work.  But you have more chances, well in one way you have more chances to test out these adaptive  responses at work because it's more or less a daily thing, right?  Five days a week or whatever it is.  So some of those adaptive responses that we kind of worked on together, right, you could  apply those.  Okay.  And, you know, the thing about adaptive responses is they're not always short.  Right?  The automatic thoughts could be short.  It can even be images.  They're not necessarily even complete sentences, right?  Like maybe you have an image of your cat in an unfortunate situation.  So it's not necessarily spelled out in English.  Right.  Like a sentence.  adaptive responses, well they could be images too, but the ones I'm talking  about are the really sentences that you're repeating back consciously to  yourself. So it's important to have them prepared and ready to go. So I often ask  clients to kind of write them out and have them available so that when that  thought comes about and it seems like you're pretty good at identifying it, you  you know what thoughts are triggering anxiety, you would read, eventually you would have  to read it because you'd memorize it, but initially you'd read the automatic thought.  I mean, I'm sorry, the adaptive response.  And that would counter the automatic thought.  Might not the first time, might not the second time, but over time we believe it and I've  found that it changes how often and how intense the automatic thoughts come in.  the conscious thinking, the adaptive responding.  Does that make sense?""",1900.98,1919.1
023_177,023,177,2,"They know. I mean, I've threatened to put a camera in the house so I can like, there's a thing you can, you can remote access to your house,  and there's a button your animal can push and call you. And I've joked about at work, I'm like, well my cat calls me, y'all.  You know, I really thought about it, seriously, that I could check on them. That would lessen my anxiety.  I wouldn't have to go home, I could just look in and see what they're doing.  I have thought of this and my co-workers know I worry about them.  They're aware of that?  Yeah, they would help support me and not be so anxious probably.","Therapist: ""Does that make sense?""
Patient: ""Definitely, yes.""
Therapist: ""So if you could, between now and the next session, write down some of the adaptive responses.  Okay.  We discussed the ones you've already used and then work to identify the automatic thoughts  thoughts at work and they come up. Work to identify them and then consciously repeat  those adaptive responses back when you have those thoughts.  Okay.  So you're pairing the self-talk, the adaptive responses with the automatic thoughts. So  that thought comes, right? And then you have the adaptive response. And you're repeating  it, you know, it's an internal. You're repeating it, you're just thinking it. Not necessarily  So yeah, it's out loud, although that would certainly be okay too, but I don't know how your co-workers respond to something like that.""",1986.16,2014.72
023_179,023,179,2,"I know, I was thinking it would make it worse.","Therapist: ""So if you could, between now and the next session, write down some of the adaptive responses.  Okay.  We discussed the ones you've already used and then work to identify the automatic thoughts  thoughts at work and they come up. Work to identify them and then consciously repeat  those adaptive responses back when you have those thoughts.  Okay.  So you're pairing the self-talk, the adaptive responses with the automatic thoughts. So  that thought comes, right? And then you have the adaptive response. And you're repeating  it, you know, it's an internal. You're repeating it, you're just thinking it. Not necessarily  So yeah, it's out loud, although that would certainly be okay too, but I don't know how your co-workers respond to something like that.""
Patient: ""They know. I mean, I've threatened to put a camera in the house so I can like, there's a thing you can, you can remote access to your house,  and there's a button your animal can push and call you. And I've joked about at work, I'm like, well my cat calls me, y'all.  You know, I really thought about it, seriously, that I could check on them. That would lessen my anxiety.  I wouldn't have to go home, I could just look in and see what they're doing.  I have thought of this and my co-workers know I worry about them.  They're aware of that?  Yeah, they would help support me and not be so anxious probably.""
Therapist: ""Yeah, and putting in a security type measure, you know, could lessen the anxiety or it could  create new anxieties.""",2025.16,2028.26
023_183,023,183,4,Should I like try to measure my level of anxiety?,"Therapist: ""And I don't know which.  So I think if you're okay with it, we'll start with the adaptive responses.""
Patient: ""Yes, yeah, I'd rather do that first.""
Therapist: ""See how that works out.  And we have other options including security systems and such to try out in the future  if necessary.  Let's try the adaptive responding and try to keep track of how well it works for you.  Like what your thoughts and feelings were after you applied it.""",2053.98,2056.92
024_001,024,1,1,"Hi, Jeff. How are you doing today? I'm all right.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""",24.43,26.49
024_003,024,3,4,"I'm still having difficulties at work, and that's why I'm glad I have a session today, because it hasn't stopped. The frustration and anger, it's there ten times more than before.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""
Patient: ""Hi, Jeff. How are you doing today? I'm all right.""
Therapist: ""Thanks for actually seeing me today. Sure. How have you been? I know last time I spoke with you, you were having some difficulties at work.""",38.65,52.31
024_005,024,5,4,"Yes. There seems to be a lot that's going on, and I continually don't get the help that I need, not only from my coworker, but also my supervisor. So it just feels so that everything is my responsibility, and I have to make it happen. And if I don't make it happen, it's not going to happen. And then it's just all on me. But I also don't want us to not succeed. So I don't know how to navigate those two fields.","Therapist: ""Thanks for actually seeing me today. Sure. How have you been? I know last time I spoke with you, you were having some difficulties at work.""
Patient: ""I'm still having difficulties at work, and that's why I'm glad I have a session today, because it hasn't stopped. The frustration and anger, it's there ten times more than before.""
Therapist: ""So you're really frustrated, way more than normal, and angry.""",57.96,94.31
024_007,024,7,5,"So I talked to my supervisor about my coworker actually assisting me with some of the projects that we have going on. And my supervisor keeps on saying, oh, they're helping out and they're doing what they're supposed to do. but they're not doing what they're supposed to do because I end up doing their work. Say, for example, last week we actually had to turn in this huge report that we were working on for over a month. Literally, my coworker came to me on Monday and said, I didn't do my portion of the report. And I was just like, we had a month to work on this. And so I spent the next three days doing everything for their part of the report. Luckily, I had already finished my part of the report and then combined it and actually turned it into my supervisor. Of course, we get the, oh, this is a wonderful, great job that you guys did. And I'm just like, you guys?","Therapist: ""So you're really frustrated, way more than normal, and angry.""
Patient: ""Yes. There seems to be a lot that's going on, and I continually don't get the help that I need, not only from my coworker, but also my supervisor. So it just feels so that everything is my responsibility, and I have to make it happen. And if I don't make it happen, it's not going to happen. And then it's just all on me. But I also don't want us to not succeed. So I don't know how to navigate those two fields.""
Therapist: ""So the weight of the work assignments is really on you. You feel that pressure. You want to do right by your employer, and there's an emotional toll this has taken on you. Has it reached a point where you've talked to your, it's a coworker supervisor you mentioned? Yes.""",120.43,178.62
024_011,024,11,4,So this is almost the expectation when you get to work? Correct. Correct. I think that you hit the nail on the head. It's expected of me. And nobody actually sees it as an expectation anymore.,"Therapist: ""As if you both contributed equally. Correct. Correct. So in three days, you made up for A month's worth of work? Yes. So I could see how that could be stressful. It's very, very taxing. Very, very taxing. And this wasn't an isolated incident?""
Patient: ""Oh, no.""
Therapist: ""This has been going on for probably three or four months now.""",202.96,214.04
024_013,024,13,3,"planning on correct and sometimes that work actually comes out for my supervisor but it's mostly coming from my coworker like I know they're not going to do their portion so I just automatically start doing it anyway Because you know you kind of have to. I know it's going to fall on my lap either today, tomorrow, next week. So I would rather be preemptive and actually start it then so that I'm not rushing like I was last week to finish a month's worth of work in three days' worth of time. So I'm not as stressed.","Therapist: ""This has been going on for probably three or four months now.""
Patient: ""So this is almost the expectation when you get to work? Correct. Correct. I think that you hit the nail on the head. It's expected of me. And nobody actually sees it as an expectation anymore.""
Therapist: ""It's just what you do. It's just what I do. So you can know that going into work the next day you go in, whenever that is, that there's always this probability, this chance that you could have work just thrown on you that""",232.86,268.13
024_015,024,15,5,"I talk to the supervisor. I'm afraid, well, I can't really talk to the coworker because I don't feel as though that's my position. However, I have expressed my frustration, my anger, my disappointment with my supervisor, and my supervisor keeps on saying, oh, I'll fix it, or oh, it doesn't seem as though that they haven't done their piece of the work because do all of it it's turned in so I have but there doesn't seem to be anything happening outside what kind of options in terms of your job you feel like you have now I don't feel as though that I have any options that's the thing I think that either if I can if I don't do the work and we fail we're going to our entire office. And if it impacts our entire office, like, somebody might be let go. And because I am the newest person in our office, I feel as though that that's going to be me. So I need to protect my job by doing not only my work, but my co-workers work and sometimes my supervisors work.","Therapist: ""It's just what you do. It's just what I do. So you can know that going into work the next day you go in, whenever that is, that there's always this probability, this chance that you could have work just thrown on you that""
Patient: ""planning on correct and sometimes that work actually comes out for my supervisor but it's mostly coming from my coworker like I know they're not going to do their portion so I just automatically start doing it anyway Because you know you kind of have to. I know it's going to fall on my lap either today, tomorrow, next week. So I would rather be preemptive and actually start it then so that I'm not rushing like I was last week to finish a month's worth of work in three days' worth of time. So I'm not as stressed.""
Therapist: ""So you've tried to... address this in the framework, in the context of your work. You've talked to the supervisor, to the coworker.""",278.69,355.95
024_017,024,17,2,"I think, yes. I think that they understand that since they're the senior member on team, it would be most likely that the junior member will possibly be let go if a budget cut were to happen.","Therapist: ""So you've tried to... address this in the framework, in the context of your work. You've talked to the supervisor, to the coworker.""
Patient: ""I talk to the supervisor. I'm afraid, well, I can't really talk to the coworker because I don't feel as though that's my position. However, I have expressed my frustration, my anger, my disappointment with my supervisor, and my supervisor keeps on saying, oh, I'll fix it, or oh, it doesn't seem as though that they haven't done their piece of the work because do all of it it's turned in so I have but there doesn't seem to be anything happening outside what kind of options in terms of your job you feel like you have now I don't feel as though that I have any options that's the thing I think that either if I can if I don't do the work and we fail we're going to our entire office. And if it impacts our entire office, like, somebody might be let go. And because I am the newest person in our office, I feel as though that that's going to be me. So I need to protect my job by doing not only my work, but my co-workers work and sometimes my supervisors work.""
Therapist: ""So you're really figuratively fighting for survival? Correct. Do you think your coworker is aware that if there is a failure with getting projects done, that you would be the one that would be let go?""",372.59,389.31
024_019,024,19,4,"I think most of my anger is directed at my supervisor for not doing something because they can clearly see that something's wrong or that I'm handling a lot more, but they're not willing to step in. And I think a little bit of that anger is also at myself because I haven't just said to my co-worker, like, you need to step up and you need to do this. So I'm a little disappointed and angry at myself as well.","Therapist: ""So you're really figuratively fighting for survival? Correct. Do you think your coworker is aware that if there is a failure with getting projects done, that you would be the one that would be let go?""
Patient: ""I think, yes. I think that they understand that since they're the senior member on team, it would be most likely that the junior member will possibly be let go if a budget cut were to happen.""
Therapist: ""So you're really... largely stuck with having to do the work. Yes. How about the emotions involved? You mentioned before the frustration and anger. Anger directed at?""",405.74,437.86
024_021,024,21,2,I don't have the confidence to actually confront my coworker.,"Therapist: ""So you're really... largely stuck with having to do the work. Yes. How about the emotions involved? You mentioned before the frustration and anger. Anger directed at?""
Patient: ""I think most of my anger is directed at my supervisor for not doing something because they can clearly see that something's wrong or that I'm handling a lot more, but they're not willing to step in. And I think a little bit of that anger is also at myself because I haven't just said to my co-worker, like, you need to step up and you need to do this. So I'm a little disappointed and angry at myself as well.""
Therapist: ""You're angry at yourself. So you feel like you don't have the ability or courage to...""",449.21,455.71
024_023,024,23,2,"I think it would be good for them to understand how their lack of participation in our projects is impacting me and could also possibly impact our entire department. However, I don't know exactly how to say that and not come off as, I know more than you, even though that you've been here longer than me.","Therapist: ""You're angry at yourself. So you feel like you don't have the ability or courage to...""
Patient: ""I don't have the confidence to actually confront my coworker.""
Therapist: ""All right. So before we dig into that too much, is it a good idea to confront the coworker?""",465.94,491.01
024_025,024,25,2,I don't want to say 100%. I will say 99.9% say that they will not probably be receptive if I said that.,"Therapist: ""All right. So before we dig into that too much, is it a good idea to confront the coworker?""
Patient: ""I think it would be good for them to understand how their lack of participation in our projects is impacting me and could also possibly impact our entire department. However, I don't know exactly how to say that and not come off as, I know more than you, even though that you've been here longer than me.""
Therapist: ""So you're searching for a friendly, understanding way to convey a tough subject matter to someone who may or may not be receptive, that you may presume that they're more likely to not""",510.76,521.86
024_027,024,27,2,"It could make things in the office be a little bit more tense. It could possibly put an additional spotlight on what I am doing or rather not doing, which I'm doing everything, so what I'm doing. It could cause friction between my coworker and my supervisor. It could just cause this unwarranted or unnecessary stress for me to actually just go and say something to them. lose your job or anything like that no i don't think that i could lose my job i don't think that my if i said something to my co-worker i don't i hope that they wouldn't go to like our human resources department um but i i don't know if that's","Therapist: ""So you're searching for a friendly, understanding way to convey a tough subject matter to someone who may or may not be receptive, that you may presume that they're more likely to not""
Patient: ""I don't want to say 100%. I will say 99.9% say that they will not probably be receptive if I said that.""
Therapist: ""So you're in for a bit of a battle. Yes. And that would start it. Yes. So one option is to avoid it and continue to do the work. And that's unpleasant, but you survived. Another option is to, in the gentlest way possible, introduce that confrontation to the relationship and then deal with the fallout of that. Yes. And any potential benefit that might happen. Yes. So let's look at that. What's the worst that can happen from making that, confronting that cohort?""",558.49,614.14
024_029,024,29,2,"When you say it like that, that sounds really easy and non-confrontational. Were you thinking of, did you have another narrative in mind? Well, I was actually thinking about going to them and saying, hey, you remember this report? You remember this report? You remember this report? You didn't do this, this, this, this, this, this, this, this. And I had to pick up your slack on all of that. Can we not make that happen again in the past?","Therapist: ""So you're in for a bit of a battle. Yes. And that would start it. Yes. So one option is to avoid it and continue to do the work. And that's unpleasant, but you survived. Another option is to, in the gentlest way possible, introduce that confrontation to the relationship and then deal with the fallout of that. Yes. And any potential benefit that might happen. Yes. So let's look at that. What's the worst that can happen from making that, confronting that cohort?""
Patient: ""It could make things in the office be a little bit more tense. It could possibly put an additional spotlight on what I am doing or rather not doing, which I'm doing everything, so what I'm doing. It could cause friction between my coworker and my supervisor. It could just cause this unwarranted or unnecessary stress for me to actually just go and say something to them. lose your job or anything like that no i don't think that i could lose my job i don't think that my if i said something to my co-worker i don't i hope that they wouldn't go to like our human resources department um but i i don't know if that's""
Therapist: ""So really you're just talking about going to them and saying, hey, things feel a bit imbalanced. Is there anything maybe we could do to level up the work across us a little better?""",630.96,662.21
024_031,024,31,1,"There might be. One of the things for each of our projects, we have a timeline, but we don't have a set timeline within the office space to actually say, I'm going to have this done by this date and you're going to have this done by this date. That's something that I could suggest so that we can hold each other accountable for the work that we have to do. So that might be a way that I could start to broach the subject.","Therapist: ""So really you're just talking about going to them and saying, hey, things feel a bit imbalanced. Is there anything maybe we could do to level up the work across us a little better?""
Patient: ""When you say it like that, that sounds really easy and non-confrontational. Were you thinking of, did you have another narrative in mind? Well, I was actually thinking about going to them and saying, hey, you remember this report? You remember this report? You remember this report? You didn't do this, this, this, this, this, this, this, this. And I had to pick up your slack on all of that. Can we not make that happen again in the past?""
Therapist: ""Okay, so maybe a little more direct than what I was talking about. Yeah. Which is... In part, an expression of the way you feel. Yes. You have feelings that match that pretty well. Very much so. Do you feel, I know you mentioned a lack of confidence in this area, but do you feel like you could approach it with them where they have a potential win in the end? So before you answer that, let me explain that a little. When we confront people... If we don't leave them an avenue to kind of protect their position in the relationship a bit, it's more of a trapping or a cornering. But if we leave an avenue where they can make changes without really having to take full responsibility or blame, sometimes that's more productive, especially for the first introduction of a subject matter, like the first time you confront them. Clearly, that doesn't work. There's other avenues, different types of confrontation. But I'm wondering if there's a way, so back to my original question, if there's a way that they can be confronted that leaves them a win in the whole process.""",751.68,777.95
024_034,024,34,1,"I believe if I was able to have a conversation where we didn't necessarily talk about the distribution of work, but if we had a conversation on what we're both good at and how we can actually complement each other with doing our work, I think that that would be a better conversation so that they could take what I had to say a lot easier. hey I understand that you're not good at doing that this type of report however I'm really good at doing this however I see that you have excellent skills when it comes to formatting and getting everything together and actually submitting it to whom it needs to get to can we actually start to distribute the work that way so that they can do what's what's going to be productive for them, and I can do what's going to be productive for me.","Patient: ""There might be. One of the things for each of our projects, we have a timeline, but we don't have a set timeline within the office space to actually say, I'm going to have this done by this date and you're going to have this done by this date. That's something that I could suggest so that we can hold each other accountable for the work that we have to do. So that might be a way that I could start to broach the subject.""
Patient: ""my head.""
Therapist: ""And that way may not be really consistent with the way you feel. It's definitely not consistent with the way I feel, no. What method, and I don't, you know, this isn't a question where I presume to know the answer, what method do you think could lead to a better outcome, has a better chance of leading to a better outcome?""",813.0,874.1
024_038,024,38,4,"Yeah, but I think that if I do have that conversation that way, I think that that frustration and anger that I have had, I think it would slowly disappear because then I know that they would still be doing something for the projects that we have to complete. So I think that my past feelings, they would slowly diminish because I know that","Therapist: ""So really what you're suggesting is not even confrontation, or it's just going in and saying, you have some strengths, they have some strengths, wouldn't it be great if we could explore those strengths in the way we divide up the responsibilities?""
Patient: ""Yeah.""
Therapist: ""Yeah, yeah. Yeah. If you went and said that, would it be a part of you that is kind of stuffing down those emotions of frustration during that talk?""",901.9,927.89
024_040,024,40,2,It's probably around 3 o'clock. Generally there's a 3 o'clock slump where everybody goes out and grabs coffee or something and I think that during that time that might be a good time to possibly bring up that conversation or at least broach the subject. I can actually probably broach that subject with my supervisor at that time to see if they think that that might be a good idea.,"Therapist: ""Yeah, yeah. Yeah. If you went and said that, would it be a part of you that is kind of stuffing down those emotions of frustration during that talk?""
Patient: ""Yeah, but I think that if I do have that conversation that way, I think that that frustration and anger that I have had, I think it would slowly disappear because then I know that they would still be doing something for the projects that we have to complete. So I think that my past feelings, they would slowly diminish because I know that""
Therapist: ""Okay, so you may have some feelings at that moment, but looking at the outcome, as you think about the outcome, you could think, well, this is tough right now, but I feel hopeful that it's going to work out in the future. Yes. Correct. And that could give you the confidence, the ability to kind of push through that exercise, that discussion. Correct. Yep. Is there a certain time of the day where you feel less frustrated?""",963.68,992.28
024_042,024,42,1,"Basically, it all depends on what projects we have coming in, so I can't give a specific day. I know Monday's not a good day just because no one wants to be at work on Monday, yeah. And Friday, it's probably not a good day because everybody's just like, I just want to go home and have fun the whole weekend. So it's probably Tuesday, Wednesday, or Thursday that's probably the best time to have that conversation.","Therapist: ""Okay, so you may have some feelings at that moment, but looking at the outcome, as you think about the outcome, you could think, well, this is tough right now, but I feel hopeful that it's going to work out in the future. Yes. Correct. And that could give you the confidence, the ability to kind of push through that exercise, that discussion. Correct. Yep. Is there a certain time of the day where you feel less frustrated?""
Patient: ""It's probably around 3 o'clock. Generally there's a 3 o'clock slump where everybody goes out and grabs coffee or something and I think that during that time that might be a good time to possibly bring up that conversation or at least broach the subject. I can actually probably broach that subject with my supervisor at that time to see if they think that that might be a good idea.""
Therapist: ""Okay, to get some buy-in at that level. So maybe a little bit in the afternoon at 3 o'clock. Is there a particular day of the week that's better for a discussion like that? There's less stress, less going on? No.""",1007.41,1032.41
024_044,024,44,2,"What could you rehearse? For one thing, I think that I need to look at what I'm good at or what I think I'm good at, and then also compare that to what I believe my co-worker's good at, so I can figure out what duties can be split up. So that's one thing. So maybe writing that down. Writing that down. Also, I think that me going into the situation because I don't have the confidence, I think that if I write down what I think I want to say or need to say, I think that might be a way for me to keep the conversation on track and not letting it go off into left field somewhere.","Therapist: ""Okay, to get some buy-in at that level. So maybe a little bit in the afternoon at 3 o'clock. Is there a particular day of the week that's better for a discussion like that? There's less stress, less going on? No.""
Patient: ""Basically, it all depends on what projects we have coming in, so I can't give a specific day. I know Monday's not a good day just because no one wants to be at work on Monday, yeah. And Friday, it's probably not a good day because everybody's just like, I just want to go home and have fun the whole weekend. So it's probably Tuesday, Wednesday, or Thursday that's probably the best time to have that conversation.""
Therapist: ""And this is a topic you certainly thought about, you had feelings about. What do you think you could do to prepare for that talk?""",1041.26,1088.55
024_046,024,46,2,"I think that if when it comes to talking about our strengths and if my coworker just is like, I'm perfect at everything, I'm just like, no, you're not, I think that that would I think veer the conversation in a different direction that I don't think that I would be able to get it back on track. So I could possibly, instead of saying, these are the things that I think that you're good at, I can ask them, what do you feel as though that you're good at? So that when we get into the discussion a little bit more, I can actually use their feedback and use their ideas to then figure out how we can divvy up our work.","Therapist: ""And this is a topic you certainly thought about, you had feelings about. What do you think you could do to prepare for that talk?""
Patient: ""What could you rehearse? For one thing, I think that I need to look at what I'm good at or what I think I'm good at, and then also compare that to what I believe my co-worker's good at, so I can figure out what duties can be split up. So that's one thing. So maybe writing that down. Writing that down. Also, I think that me going into the situation because I don't have the confidence, I think that if I write down what I think I want to say or need to say, I think that might be a way for me to keep the conversation on track and not letting it go off into left field somewhere.""
Therapist: ""You don't want it to go off in left field. That's a goal. That's something you want to avoid. Is there a specific trigger or event that when it comes along in that conversation that you may see that and say, I need to just break off this conversation or else I'm risking going off in the left field?""",1108.85,1155.08
024_048,024,48,2,"I think it's something that I could work up to doing. I don't know if I could do that tomorrow, but it's something I think that I could work up to doing.","Therapist: ""You don't want it to go off in left field. That's a goal. That's something you want to avoid. Is there a specific trigger or event that when it comes along in that conversation that you may see that and say, I need to just break off this conversation or else I'm risking going off in the left field?""
Patient: ""I think that if when it comes to talking about our strengths and if my coworker just is like, I'm perfect at everything, I'm just like, no, you're not, I think that that would I think veer the conversation in a different direction that I don't think that I would be able to get it back on track. So I could possibly, instead of saying, these are the things that I think that you're good at, I can ask them, what do you feel as though that you're good at? So that when we get into the discussion a little bit more, I can actually use their feedback and use their ideas to then figure out how we can divvy up our work.""
Therapist: ""Right, so do you like this idea that we've kind of been bouncing around of a mild, productive, strength-based conversation with the coworker? Yeah.""",1169.8,1182.61
025_004,025,4,4,It's still a struggle. I'm planning a surprise party for my husband and his mother doesn't talk to me.,"Therapist: ""Hi Susan, how are you doing today?""
Patient: ""I'm okay.""
Therapist: ""You're okay? I know that when you saw me last time, you were going through a bit of a struggle. How are things going with that?""",34.89,48.43
025_010,025,10,4,"Yeah. So she doesn't really try to interact with her grandkids or me. And the way I was raised is the matriarch is going to, you know, make all attempts to, you know, keep the family connected. So I tried to call her. and let the kids talk to her, but she won't answer her phone. And now with the party coming up, I would like her to be there, but she's not responding.","Therapist: ""That must make things tense?""
Patient: ""Really tense.""
Therapist: ""Really tense.""",61.33,101.79
025_012,025,12,2,"Yeah. We've been married for five years and dated for about 11, but we dated in the past and lost part ways and came back together later.","Therapist: ""Really tense.""
Patient: ""Yeah. So she doesn't really try to interact with her grandkids or me. And the way I was raised is the matriarch is going to, you know, make all attempts to, you know, keep the family connected. So I tried to call her. and let the kids talk to her, but she won't answer her phone. And now with the party coming up, I would like her to be there, but she's not responding.""
Therapist: ""And just so I can get a little bit of background to understand, is this relationship new, or this dynamic new, or have you been part of this family for a while?""",112.64,135.07
025_014,025,14,4,"Yeah, she, um, so during, when I, I got pregnant with my first daughter before we got married and he was away at school. So she felt that I was trying to interrupt his studies, um, and trap him. So she's been, um, She disapproved of the relationship from the beginning. For the wedding, she had insight and she kind of like just took over my wedding.","Therapist: ""And just so I can get a little bit of background to understand, is this relationship new, or this dynamic new, or have you been part of this family for a while?""
Patient: ""Yeah. We've been married for five years and dated for about 11, but we dated in the past and lost part ways and came back together later.""
Therapist: ""And this dynamic with his mother not talking to you, that's been the whole time?""",145.32,185.08
025_018,025,18,4,"Well, when I was pregnant, she told me.","Therapist: ""Like in terms of organizing it?""
Patient: ""Yeah.""
Therapist: ""So... So, you're saying that she disapproves and that she felt as though you were trying to trap her son. How do you, how did you come by this information?""",206.97,210.27
025_022,025,22,4,"Yeah. Yeah, she, well, I guess not maybe. She kind of said that he's in school, he's not ready for a kid, and suggested that I have an abortion.","Therapist: ""She told you, okay. So it's not something that you were reading into it or guessing, it was fairly direct.""
Patient: ""Yeah.""
Therapist: ""And in kind of those words?""",220.83,233.46
025_024,025,24,3,I think it's the... My feelings is the whole relationship because she's just... Because now he graduated. He has a great job. We have three kids. He's able to do whatever he wants to do. And she's still behaving the same way. So I would think it's the whole relationship.,"Therapist: ""And in kind of those words?""
Patient: ""Yeah. Yeah, she, well, I guess not maybe. She kind of said that he's in school, he's not ready for a kid, and suggested that I have an abortion.""
Therapist: ""So she made that suggestion to you and made it clear that she disapproved of the whole relationship? Or just the timing?""",249.04,272.42
025_028,025,28,4,"Some aspects, I guess. I really believe in family. My family's not here. So I think it's really important that the family I'm a part of is together. So if I'm the cause that this family is not together, It's really hurtful.","Therapist: ""So you feel as though your relationship with him has been productive for you, for him, for the children? Like it's been a success?""
Patient: ""No.""
Therapist: ""No? You don't feel that way? You feel it's been...""",286.65,317.75
025_030,025,30,4,"I'll say, like, maybe the last, like, maybe three years.","Therapist: ""No? You don't feel that way? You feel it's been...""
Patient: ""Some aspects, I guess. I really believe in family. My family's not here. So I think it's really important that the family I'm a part of is together. So if I'm the cause that this family is not together, It's really hurtful.""
Therapist: ""So you're really hurt by all this and you feel like all these relationships, none of them have been productive and successful. So this has been anxiety-provoking, frustrating, sad. And how long have you been in this, with these emotions, with the anxiety and sadness?""",346.85,352.78
025_032,025,32,5,"Yeah. Because we tend to end up in, like, the same mix of, like, people and activities. And she treats us, well, she treats me like I'm not even there. And then there's the kids that's just... I don't know what to say to them.","Therapist: ""So you're really hurt by all this and you feel like all these relationships, none of them have been productive and successful. So this has been anxiety-provoking, frustrating, sad. And how long have you been in this, with these emotions, with the anxiety and sadness?""
Patient: ""I'll say, like, maybe the last, like, maybe three years.""
Therapist: ""Three years you've been suffering this. Yeah. This way.""",357.58,379.46
025_034,025,34,2,"Well, I guess they still need him for stuff. So he can, like, talk to them. They'll talk to him. He still pays, like, for her daughter, his little sister, like Bonedale. She's an adult and she lives with her mom. So they still depend on her for certain things.","Therapist: ""Three years you've been suffering this. Yeah. This way.""
Patient: ""Yeah. Because we tend to end up in, like, the same mix of, like, people and activities. And she treats us, well, she treats me like I'm not even there. And then there's the kids that's just... I don't know what to say to them.""
Therapist: ""So she treats you poorly, like you're not there. She doesn't interact much with the kids or at all. Right. And how about with your husband, their son?""",394.64,421.6
025_035,025,35,2,I think he's also kind of dependent on them.,"Patient: ""Yeah. Because we tend to end up in, like, the same mix of, like, people and activities. And she treats us, well, she treats me like I'm not even there. And then there's the kids that's just... I don't know what to say to them.""
Therapist: ""So she treats you poorly, like you're not there. She doesn't interact much with the kids or at all. Right. And how about with your husband, their son?""
Patient: ""Well, I guess they still need him for stuff. So he can, like, talk to them. They'll talk to him. He still pays, like, for her daughter, his little sister, like Bonedale. She's an adult and she lives with her mom. So they still depend on her for certain things.""",434.55,438.71
025_037,025,37,4,"Yeah, because I kind of feel like there's no way he doesn't see how she behaves and knows how she behaves and I don't feel that he is receptive to my pain.","Patient: ""Well, I guess they still need him for stuff. So he can, like, talk to them. They'll talk to him. He still pays, like, for her daughter, his little sister, like Bonedale. She's an adult and she lives with her mom. So they still depend on her for certain things.""
Patient: ""I think he's also kind of dependent on them.""
Therapist: ""It goes both ways.""",441.63,462.08
025_039,025,39,3,"No, um, so she at one point in time I think said something to him about the, when I was pregnant the first time, um, which was kind of like insight into her feelings about what was going on and I think he kind of just like brushed it off like she was just being a mom kind of situation but he has to be aware of his kids don't go over there she doesn't call them I had an incident where it was grandparents day so I suggested to him that he you know take the kids over there and, like, call her and just kind of, like, you know, celebrate Grandparents' Day, you know? And, um, so he came back and it's like, um, his mom said, oh, this must have been Susan's idea. Like, what does that mean?","Therapist: ""It goes both ways.""
Patient: ""Yeah, because I kind of feel like there's no way he doesn't see how she behaves and knows how she behaves and I don't feel that he is receptive to my pain.""
Therapist: ""conveyed to him that you have pain and this is, this is, you have it. So he doesn't know what's going on?""",473.39,535.59
025_041,025,41,4,"Well, I tried to call her regarding a party and I called like I guess like every day for like maybe a week and when she finally answered the phone she just said, Susan stop calling me and hung up the phone.","Therapist: ""conveyed to him that you have pain and this is, this is, you have it. So he doesn't know what's going on?""
Patient: ""No, um, so she at one point in time I think said something to him about the, when I was pregnant the first time, um, which was kind of like insight into her feelings about what was going on and I think he kind of just like brushed it off like she was just being a mom kind of situation but he has to be aware of his kids don't go over there she doesn't call them I had an incident where it was grandparents day so I suggested to him that he you know take the kids over there and, like, call her and just kind of, like, you know, celebrate Grandparents' Day, you know? And, um, so he came back and it's like, um, his mom said, oh, this must have been Susan's idea. Like, what does that mean?""
Therapist: ""So you're sensing a lot of hostility, but there haven't been, lately anyway, a lot of direct conversations.""",546.83,563.04
025_043,025,43,1,"I mean, I would want to. I think, you know, if I was to hang in there and be the best parent I can be, maybe eventually she'll want to have a relationship with her grandkids. I'm not really worried about her liking me as much.","Therapist: ""So you're sensing a lot of hostility, but there haven't been, lately anyway, a lot of direct conversations.""
Patient: ""Well, I tried to call her regarding a party and I called like I guess like every day for like maybe a week and when she finally answered the phone she just said, Susan stop calling me and hung up the phone.""
Therapist: ""So that's fairly direct. Yeah. So there has been that. Do you have any evidence, is there any evidence that suggests that her behavior is going to change?""",581.24,600.5
025_053,025,53,2,"Yeah. Because I think, I think it's important to have family, and right now all I want to do is, I think it would be best if we moved away, like to another state, maybe.","Therapist: ""Okay. So even with that, You hang in there, and it's your hope that she'll come around, that your attitude will change? Yeah. But so far, it doesn't sound like she's given you a lot of evidence, or presented a lot of evidence, that that's a likely outcome. No. But you can be hopeful, of course.""
Unknown: ""Yeah.""
Therapist: ""Right. How about your emotions? The sadness, the anxiety? Is there something, is that something you want to work on to resolve those, absent of a change in her?""",652.58,670.11
025_055,025,55,2,"Yeah, so I'm wondering if that's just because I'm sad, you know? So maybe if I was to work on my sadness, then maybe I'll feel more okay with being here.","Therapist: ""Right. How about your emotions? The sadness, the anxiety? Is there something, is that something you want to work on to resolve those, absent of a change in her?""
Patient: ""Yeah. Because I think, I think it's important to have family, and right now all I want to do is, I think it would be best if we moved away, like to another state, maybe.""
Therapist: ""You think it would be better to move away?""",673.14,685.86
025_060,025,60,1,"Yeah, because I really can't control her. So, yeah.","Therapist: ""where it would be understandable to be sad and frustrated. Do you feel as though you can move through all this if nothing in her changes? So let's just assume for a second that her behavior will never change. It may, but we don't know that. So let's just run an assumption that it is the way it is, like this is what you're facing. Can you, at some level, be okay with all this in terms of frustration and sadness?""
Patient: ""I think so. I can try.""
Therapist: ""I mean, is that a goal?""",749.3,753.67
025_062,025,62,3,"I think that it's going to be hard because I do consider how her behavior affects my kids. but I know I probably would have to let go of one of her approval in order to be a better, more involved parent instead of just allowing myself to stress over that relationship. So the invite has always been there. She can always engage with the kids. She has contact with her son, so it's not like, you know, I'm stopping her from being involved.","Therapist: ""I mean, is that a goal?""
Patient: ""Yeah, because I really can't control her. So, yeah.""
Therapist: ""It's not ideal, though. No. So the idea would be if she would warm up to you and engage in the family kind of as you, as you mentioned before, in a more inviting role and friendlier and accepting. Yeah. That's what you'd like in a, kind of in a perfect scenario. There hasn't been much in our discussion here, in the way of evidence, that seems to lead to that as a conclusion, like that some change is going to occur. Does that make sense? Again, it could happen. I have no way of knowing. It just doesn't seem likely based on what you've introduced. So that leaves you not on your own, but that leaves you without her. as a support to work through all these emotions. What do you think about when I say that?""",835.37,884.35
025_066,025,66,2,Yeah. I think I'm a pretty likable person.,"Therapist: ""So what you're saying is that that desire for approval, that's what's causing these symptoms? That's what's maintaining them?""
Unknown: ""Yeah.""
Therapist: ""And that's what you want to be able to let go of, is that desire? So you have a belief at some level that she must give you approval. There's a belief in there somewhere that reads something like that. Yeah. She should give me approval?""",929.07,931.1
025_070,025,70,2,"It's okay if... Okay, so I believe that I'm a likable person, but it's okay that others might not feel the same.","Therapist: ""Okay. You're a likable person, right? I would agree. You're a likable person and it would make sense she should give you approval. That's kind of the belief. And the consequence of that belief, when it meets the reality that she doesn't seem to be giving you approval, is that sadness and frustration and anxiety. Does that make sense? So that belief The belief that you're a likable person is realistic and that seems like a useful belief. But the belief that she should like you, that belief doesn't seem to be serving you as well.""
Patient: ""No, it's not.""
Therapist: ""It doesn't seem to be. Is there another belief that could be substituted in for that? Think about that belief as very rigid. She must, she should like me. That doesn't leave much room for an alternative. Is there another belief that we could work on to put in place of that, that may more accurately reflect what's going on?""",1029.99,1044.71
025_073,025,73,1,That I can't really force people to like me or everyone has their own mind and they can make their own decisions.,"Patient: ""It's okay if... Okay, so I believe that I'm a likable person, but it's okay that others might not feel the same.""
Therapist: ""All right, let's work with that. So I like keeping the I'm a likable person. I like keeping that part. So you'd say, I'm a likable person, but it's okay if some people don't see that.""
Therapist: ""So when you play that thought or resonate with that belief, what goes through your mind?""",1078.99,1092.09
025_077,025,77,1,"I can... I can probably do it when the kids, the two older ones are in Kumar. So I can do it then while I'm waiting to get out. Okay.","Therapist: ""I agree. So, everyone has their own behavior. They're going to do what they're going to do. Sometimes we understand it, sometimes we don't. But it doesn't change your essence as a good person.""
Therapist: ""Does that make sense? Yeah. Do you believe that new thought? Do you believe it more than the old thought? that she should approve of you? It's close. So there's a bit of a struggle there. So both beliefs make sense to you at the same time. So maybe as we continue to work, we can explore the the evidence behind each belief, and see if one of those beliefs tends to rise to the top, tends to get more traction. Does that make sense? Yeah. So, this week, so I'll see you again next week, so this week, between session, Would it be possible for you to kind of list out all the reasons that you are likable? Like, to list all your strengths?""
Therapist: ""Do you know of a particular day this week you might be able to do that, where you have time?""",1205.16,1216.44
025_079,025,79,1,I think I'm sensitive. I'm caring. I am generous. I am a good mother.,"Therapist: ""Do you know of a particular day this week you might be able to do that, where you have time?""
Patient: ""I can... I can probably do it when the kids, the two older ones are in Kumar. So I can do it then while I'm waiting to get out. Okay.""
Therapist: ""Do you kind of have an idea of the first few items you might put on that list?""",1221.85,1233.8
026_002,026,2,4,"Not really. I mean, it's pretty much the same pace. I'm very frustrated with the whole system. I'm working with inner city kids, African American kids, males in particular. You know, I sit and talk with these kids and I realize that there's not much I can do for them. You know, for the most part we're talking about, you know, criminal arrest, drug abuse, you know, no education. And, you know, I don't know what I can really do for them anymore. I mean, you know, I sit and talk to them, but really in terms of their statistics, it's looking pretty bad for them. So, you know, I get pretty frustrated, and it's kind of depressing to do this every day.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""
Therapist: ""Hi, Andrew. How are you doing today? Hey, Doug. Nice to see you. Nice to see you. It's been about a week since I've seen you last. I know you're having some different difficulties, particularly at work. Yeah. Any changes there?""",42.31,102.87
026_006,026,6,4,"Yeah, I mean, it's their reality, you know. A kid comes in and mom is either, dad's incarcerated, right out of the picture. Mom is either on drugs or not fully engaged. And this kid has absolutely no life skills. None. He's self-medicating from smoking marijuana. At the very least, it's marijuana. And he is just totally convinced that this is who he is the rest of his life. And he's sitting in front of me looking for answers. And I don't know if I have him.","Therapist: ""All right. So as you're working with these youths, you're looking at their circumstances.""
Patient: ""Yeah.""
Therapist: ""And you're saying the odds just don't look good for major improvements. Not at all. And that's leading you to lose hope in your ability to help them into different circumstances. Absolutely.""",126.09,174.13
026_008,026,8,4,"It's not even questions, it's more statements of, you know, this is my life. You know, the struggle is real. This is what I do. This is where I am. And, you know, anything other than this is not even, you know, not even fat. So I'm sitting here with this kid and I'm trying to draw him out of that whole mindset. We're talking about years of social conditioning. Years and years and years of it. And I just don't know if, you know, I have the skills and the tools to really break through that way of thinking.","Therapist: ""And you're saying the odds just don't look good for major improvements. Not at all. And that's leading you to lose hope in your ability to help them into different circumstances. Absolutely.""
Patient: ""Yeah, I mean, it's their reality, you know. A kid comes in and mom is either, dad's incarcerated, right out of the picture. Mom is either on drugs or not fully engaged. And this kid has absolutely no life skills. None. He's self-medicating from smoking marijuana. At the very least, it's marijuana. And he is just totally convinced that this is who he is the rest of his life. And he's sitting in front of me looking for answers. And I don't know if I have him.""
Therapist: ""What kind of questions...""",180.44,222.28
026_010,026,10,4,"That he's a drug dealer. He's going to continue to be a drug dealer. He's not going to stop. And that he's involved in gang activity. And that's his family. That's the only family he's ever known. And he's loyal to them. And that loyalty is deep. He has absolutely no, even the thought of going back to prison doesn't shake this kid.","Therapist: ""What kind of questions...""
Patient: ""It's not even questions, it's more statements of, you know, this is my life. You know, the struggle is real. This is what I do. This is where I am. And, you know, anything other than this is not even, you know, not even fat. So I'm sitting here with this kid and I'm trying to draw him out of that whole mindset. We're talking about years of social conditioning. Years and years and years of it. And I just don't know if, you know, I have the skills and the tools to really break through that way of thinking.""
Therapist: ""Alright, so can you think of a particular case, particular youth that you're working with Where you're finding the struggle. So think of one particular individual where you're frustrated. You're making these statements that kind of, this is the way it is. They don't seem like they have much hope. You don't seem like you have much hope for them. Right. So you have one in mind? Yes, I do. Okay. Yeah. So what's... What's his self-statement? What's he saying to you that you think is getting a reaction from you?""",265.46,292.9
026_012,026,12,4,"For them, jail is like going to the school courtyard, because all his boys are in jail. So I'm sitting here like, what in the hell am I doing here with this kid? You know, what kind of options do I give him when I don't even believe he has any at this point?","Therapist: ""Alright, so can you think of a particular case, particular youth that you're working with Where you're finding the struggle. So think of one particular individual where you're frustrated. You're making these statements that kind of, this is the way it is. They don't seem like they have much hope. You don't seem like you have much hope for them. Right. So you have one in mind? Yes, I do. Okay. Yeah. So what's... What's his self-statement? What's he saying to you that you think is getting a reaction from you?""
Patient: ""That he's a drug dealer. He's going to continue to be a drug dealer. He's not going to stop. And that he's involved in gang activity. And that's his family. That's the only family he's ever known. And he's loyal to them. And that loyalty is deep. He has absolutely no, even the thought of going back to prison doesn't shake this kid.""
Therapist: ""Not afraid of that? Not afraid.""",296.36,311.75
026_014,026,14,4,"That's my thought, yeah. There's no way out for him? I don't see it. I just don't. I really don't see it for him. You know, he's self-medicating. He's giving dirty urine to the probation office. He doesn't care. The judge is giving him pass after pass after pass. The kid just seems intent to live this life.","Therapist: ""Not afraid of that? Not afraid.""
Patient: ""For them, jail is like going to the school courtyard, because all his boys are in jail. So I'm sitting here like, what in the hell am I doing here with this kid? You know, what kind of options do I give him when I don't even believe he has any at this point?""
Therapist: ""So that's really your automatic thought, is I don't believe he has any options. That's what's going through your mind when he says things like he's involved in gang activity and wants to continue dealing drugs. Right. That's your thought?""",329.33,353.44
026_016,026,16,4,"this use states and his philosophy so he's saying that success is not an option as as you would think of success right and you're reacting to that and your mood is moving because of that yes it is and i mean to a certain degree i understand where he's coming from i mean i was raised uh with the understanding that you're going black that's one strike You know, you have one male, that's two strikes. A criminal arrest record, that's it. Life is over. So, you know, to a certain degree, his perception is reality, so I can't disagree with him. But at the same time, this is my job, and I'm having a very difficult time trying to give this kid any glimpse of hope, which I don't even think he really wants from me.","Therapist: ""So that's really your automatic thought, is I don't believe he has any options. That's what's going through your mind when he says things like he's involved in gang activity and wants to continue dealing drugs. Right. That's your thought?""
Patient: ""That's my thought, yeah. There's no way out for him? I don't see it. I just don't. I really don't see it for him. You know, he's self-medicating. He's giving dirty urine to the probation office. He doesn't care. The judge is giving him pass after pass after pass. The kid just seems intent to live this life.""
Therapist: ""So in a sense, your mood, the sadness, the frustration, is linked to, for example,""",366.92,424.45
026_020,026,20,4,"And that's not, I mean, you know, there's some truth to that. I don't know that, you know, criminal arrest record, a conviction in this country pretty much you know, relegates you to a certain level of society in my opinion.","Therapist: ""So it's hard for you to give the hope, and I'm sure he's looking for the hope.""
Patient: ""Yeah.""
Therapist: ""And you can understand his situation in terms of being African American, being male, and having the criminal record, and how that seems to stack the deck severely against him. Severely, yeah.""",445.84,460.7
026_022,026,22,4,"In terms of employment opportunity and, you know, things like that. So, you know, to a certain degree, I understand where he's coming from. It's just an absolute sense of hopelessness that comes from this kid. He'll sit in front of me and he'll just laugh. He'll laugh at that. Mr. D, this is my life. Why are you tripping? Why do you care so much? So I'm just starting not to care.","Therapist: ""And you can understand his situation in terms of being African American, being male, and having the criminal record, and how that seems to stack the deck severely against him. Severely, yeah.""
Patient: ""And that's not, I mean, you know, there's some truth to that. I don't know that, you know, criminal arrest record, a conviction in this country pretty much you know, relegates you to a certain level of society in my opinion.""
Therapist: ""In terms of employment opportunity?""",461.92,488.29
026_024,026,24,4,"No, I haven't. Not in so many words. Because to do that, I think, gives the kid credibility. I don't want to increase his way of thinking. I think if I agree with him, I'm doing that. Giving him a license to be an asshole, so to speak.","Therapist: ""In terms of employment opportunity?""
Patient: ""In terms of employment opportunity and, you know, things like that. So, you know, to a certain degree, I understand where he's coming from. It's just an absolute sense of hopelessness that comes from this kid. He'll sit in front of me and he'll just laugh. He'll laugh at that. Mr. D, this is my life. Why are you tripping? Why do you care so much? So I'm just starting not to care.""
Therapist: ""So you're starting to mirror that approach, the approach he's using. Yes, I am. So what's bothering you in all this, not only the circumstances, the racism, the discrimination, the circumstances in with the criminal record, that all bothers you, but also you're bothered because you're losing hope. For him? Yes. And for others like him? Yeah. Have you expressed that thought, sentiment?""",528.83,546.53
026_028,026,28,4,"Absolutely. I do believe. At my core, I do believe there is hope at some level. I believe in resilience. I think once you tap into it, you'll pretty much achieve anything. But it's just hard to peel back so many different layers with this particular generation of kids. It really takes a lot out of you. It's hard to get through. Hard to get through. Hard to penetrate that shell. So I leave work some day saying I'm not coming back. I've had enough, you know. And it gets depressing after a while.","Therapist: ""You don't want to let on that his loss of hope is really... You kind of share that in a way. Right. You get it. You understand it. Yes. His lack of hope is grounded in a lot of reality.""
Patient: ""Yes.""
Therapist: ""Exactly. At the same time, you do this work every day. Do you believe there's hope at some level?""",569.74,609.77
026_032,026,32,4,"I don't want to say what I feel because I think they don't possess the filter to be able to understand it. I think for them it's going to be a license to continue the behavior. I just sit there and bullshit them for half an hour, 45 minutes. Because what I really want to say, I don't think is going to be beneficial to them.","Therapist: ""So let's go back to that automatic thought when a youth like the one that you were talking about makes a statement like their life is essentially defined in this in these narrow parameters, like drug dealing and maybe other criminality or other behaviors that aren't productive. And you're kind of thinking there's some truth to that. And you're kind of thinking there may not be hope. That's kind of the automatic thoughts or something close to the automatic thoughts you're having.""
Patient: ""Pretty much, yeah.""
Therapist: ""Your reaction to that is to not help them or to not say what you feel to them, what's going on?""",667.22,694.23
026_034,026,34,2,"Right. At least how they would interpret the message. I think the message is, you know, for the right person with the right kind of filter, would be receivable, but I think how they interpret it is going to be the issue.","Therapist: ""Your reaction to that is to not help them or to not say what you feel to them, what's going on?""
Patient: ""I don't want to say what I feel because I think they don't possess the filter to be able to understand it. I think for them it's going to be a license to continue the behavior. I just sit there and bullshit them for half an hour, 45 minutes. Because what I really want to say, I don't think is going to be beneficial to them.""
Therapist: ""Partially because of the message, but partially because of how they would interpret the message. There's two levels to that.""",701.88,718.67
026_036,026,36,2,"That all this, that what you said is real, that, you know, criminal arrest record, you know, your circumstances growing up in the city, broken homes, racism, it's real. But at the same time, somebody else made it before you. Someone else went through this and someone else made it out. So if that was the case, I wouldn't be sitting across from you. I came from the inner city, broken homes, the same scenario. So if that were the case for all of us, then how in the hell am I sitting across from you? I'm no different. There really is nothing special about me. I wasn't an A student. I didn't get scholarships. So there has to be some quality that we tap into to really sort of center us, you know, as we go along. That's what I would like to say to them, but I'm just not too sure how it would be this evening.","Therapist: ""Partially because of the message, but partially because of how they would interpret the message. There's two levels to that.""
Patient: ""Right. At least how they would interpret the message. I think the message is, you know, for the right person with the right kind of filter, would be receivable, but I think how they interpret it is going to be the issue.""
Therapist: ""So what is the message? Tell me what you would want to say to them.""",725.66,796.29
026_038,026,38,4,"And I would be devastated by that. You know, Mr. Don say, you know, That I'm right. I didn't get the job because I'm black. I'm right because I didn't, you know, my situation is what it is because of racism, Mr. Don said. I wouldn't want that. You know, it would tarnish my reputation. Probably hurt my employment here. So, you know, I bite my tongue.","Therapist: ""So what is the message? Tell me what you would want to say to them.""
Patient: ""That all this, that what you said is real, that, you know, criminal arrest record, you know, your circumstances growing up in the city, broken homes, racism, it's real. But at the same time, somebody else made it before you. Someone else went through this and someone else made it out. So if that was the case, I wouldn't be sitting across from you. I came from the inner city, broken homes, the same scenario. So if that were the case for all of us, then how in the hell am I sitting across from you? I'm no different. There really is nothing special about me. I wasn't an A student. I didn't get scholarships. So there has to be some quality that we tap into to really sort of center us, you know, as we go along. That's what I would like to say to them, but I'm just not too sure how it would be this evening.""
Therapist: ""So your concern seems to be that they would hear the first part, but not really the second part. So they hear that their concerns are understandable and legitimate, and they've had circumstances stacked against them. They would hear that. Yes. But not so much there's a way to make it out or there's hope. Exactly, exactly.""",824.01,852.42
026_040,026,40,2,"Is there a way to deliver the message? Maybe if I switched it around. And I put the last part first. And, I don't know, I'm just brainstorming here. Maybe I don't tell them at all. Maybe I just, I make reference and have them come to the same conclusion. Give them all the tools to figure it out. Figure it out for themselves. Well, if that's the case, then how did this happen? Okay, so if that's the case, if what you're saying is true, then how does this happen? How does this person... Ask them to explain your success. My success is someone else's success. We came from the same neighborhood. How do you explain that? Same scenario. I think that might be a better way of taking this thing out of us.","Therapist: ""So your concern seems to be that they would hear the first part, but not really the second part. So they hear that their concerns are understandable and legitimate, and they've had circumstances stacked against them. They would hear that. Yes. But not so much there's a way to make it out or there's hope. Exactly, exactly.""
Patient: ""And I would be devastated by that. You know, Mr. Don say, you know, That I'm right. I didn't get the job because I'm black. I'm right because I didn't, you know, my situation is what it is because of racism, Mr. Don said. I wouldn't want that. You know, it would tarnish my reputation. Probably hurt my employment here. So, you know, I bite my tongue.""
Therapist: ""Is there a way to deliver your message kind of with the same realism and heart without including a piece that you feel like they could latch onto that would be negative?""",870.05,935.98
026_042,026,42,2,"I think it would work. I think the problem for me is I've got to buy into it first. I think that's the issue. I've really got to buy into it because I've really been inundated with so much negativity that I'm starting to believe the hype, so to speak. So before I can... You know how kids are. They know right away. If you're bullshitting them, they know right away.","Therapist: ""Is there a way to deliver your message kind of with the same realism and heart without including a piece that you feel like they could latch onto that would be negative?""
Patient: ""Is there a way to deliver the message? Maybe if I switched it around. And I put the last part first. And, I don't know, I'm just brainstorming here. Maybe I don't tell them at all. Maybe I just, I make reference and have them come to the same conclusion. Give them all the tools to figure it out. Figure it out for themselves. Well, if that's the case, then how did this happen? Okay, so if that's the case, if what you're saying is true, then how does this happen? How does this person... Ask them to explain your success. My success is someone else's success. We came from the same neighborhood. How do you explain that? Same scenario. I think that might be a better way of taking this thing out of us.""
Therapist: ""So if that's the new message, How likely do you think you'd be able to deliver that message if somebody told you they wanted to continue in an unproductive lifestyle?""",954.08,985.18
026_044,026,44,5,"I think they are very adaptable. I think their survival methods are unbelievable. But I do think they are missing some real key, just some key life skills that I want to keep them locked out and locked into their situation. One kid said to me, you know, he said, They released me from prison, but I'm still handcuffed to the system. He's right. You could see his point. I could see his point. Yeah, you're pretty much right. Because it's a mindset that although you're out of prison, mentally you're still incarcerated. And I can't pull him out of that mindset. And that's so frustrating. Here's a kid that's intelligent, but he still thinks like he's in prison. He still believes that this all happens to him because he's black. And that message is reinforced by the people he's around. So it's not just him. That's the way his boys think. That's probably the way his moms think. Because it's easier. It's easier to think, well, it's society. There's no personal responsibility. And that's a very unpopular message to have.","Therapist: ""So if that's the new message, How likely do you think you'd be able to deliver that message if somebody told you they wanted to continue in an unproductive lifestyle?""
Patient: ""I think it would work. I think the problem for me is I've got to buy into it first. I think that's the issue. I've really got to buy into it because I've really been inundated with so much negativity that I'm starting to believe the hype, so to speak. So before I can... You know how kids are. They know right away. If you're bullshitting them, they know right away.""
Therapist: ""So you feel like you need to be more genuine in your acceptance of your message before you can effectively deliver that message. Because if there's a non-authentic portion of that, they're going to find that. They're going to find it. And they're going to exploit it. So this is really, part of this is really about you losing some hope. Yes. It is, yeah. So what's your belief about their reality? So these youths that you see, have you really kind of unfiltered your belief about their chances of success?""",1034.55,1131.39
026_046,026,46,4,"I think, I said to one cat, I said, you know, you guys remind me of, like, you know, soldiers. You're like, just numb to the pain. Whatever happens, you're just numb to the pain. Just keep moving forward. Not even moving forward, just keep moving. You know, but the hardest part now is to get them to come out of that survival mode. You know, and it's depressing. I don't think the other counselors at the center see it. Or if they're just becoming immune like me, I'm becoming more like them. You know, I'm just becoming heartless and realizing, okay, this is just a job. So I'm coming in and doing my eight hours a week.","Therapist: ""So you feel like you need to be more genuine in your acceptance of your message before you can effectively deliver that message. Because if there's a non-authentic portion of that, they're going to find that. They're going to find it. And they're going to exploit it. So this is really, part of this is really about you losing some hope. Yes. It is, yeah. So what's your belief about their reality? So these youths that you see, have you really kind of unfiltered your belief about their chances of success?""
Patient: ""I think they are very adaptable. I think their survival methods are unbelievable. But I do think they are missing some real key, just some key life skills that I want to keep them locked out and locked into their situation. One kid said to me, you know, he said, They released me from prison, but I'm still handcuffed to the system. He's right. You could see his point. I could see his point. Yeah, you're pretty much right. Because it's a mindset that although you're out of prison, mentally you're still incarcerated. And I can't pull him out of that mindset. And that's so frustrating. Here's a kid that's intelligent, but he still thinks like he's in prison. He still believes that this all happens to him because he's black. And that message is reinforced by the people he's around. So it's not just him. That's the way his boys think. That's probably the way his moms think. Because it's easier. It's easier to think, well, it's society. There's no personal responsibility. And that's a very unpopular message to have.""
Therapist: ""So the youth that you work with, they've been exposed to an unpopular message, a tough message, one that permeates. It's all around them. They're exposed to it. It permeates them. But there's a part of you that really appreciates their adaptability and their survivals.""",1158.83,1204.57
026_048,026,48,4,I think the next mode is accepting the reality of where they are. This is my reality. It's not going to change unless I take some accountability from you. It's not going to change. And I think that's the hardest transition for me to make. So these things in survival mode. I call it the growth. There's survival and there's growth. So how do you go beyond your circumstances? How do you rise above your circumstances?,"Therapist: ""So the youth that you work with, they've been exposed to an unpopular message, a tough message, one that permeates. It's all around them. They're exposed to it. It permeates them. But there's a part of you that really appreciates their adaptability and their survivals.""
Patient: ""I think, I said to one cat, I said, you know, you guys remind me of, like, you know, soldiers. You're like, just numb to the pain. Whatever happens, you're just numb to the pain. Just keep moving forward. Not even moving forward, just keep moving. You know, but the hardest part now is to get them to come out of that survival mode. You know, and it's depressing. I don't think the other counselors at the center see it. Or if they're just becoming immune like me, I'm becoming more like them. You know, I'm just becoming heartless and realizing, okay, this is just a job. So I'm coming in and doing my eight hours a week.""
Therapist: ""I'm worried that exposure to this environment just makes you a certain way. It makes you disconnected from... really trying to find solutions or believing solutions are possible. When you say move out of survival mode, the survival characteristics, you admire that. What do they need to do? How do they need to move out of survival mode? What's the next mode?""",1235.78,1273.42
026_050,026,50,3,"and move forward? Except for what it is. This is real. Racism is real. Poverty is real. You hear my mother say, you know, dope fiend, and she's in jail. This is real. But how do I move beyond this now? This is what it is, and I'm realizing it. How do I move beyond this to the next stage of my development?","Therapist: ""I'm worried that exposure to this environment just makes you a certain way. It makes you disconnected from... really trying to find solutions or believing solutions are possible. When you say move out of survival mode, the survival characteristics, you admire that. What do they need to do? How do they need to move out of survival mode? What's the next mode?""
Patient: ""I think the next mode is accepting the reality of where they are. This is my reality. It's not going to change unless I take some accountability from you. It's not going to change. And I think that's the hardest transition for me to make. So these things in survival mode. I call it the growth. There's survival and there's growth. So how do you go beyond your circumstances? How do you rise above your circumstances?""
Therapist: ""So I have to accept my reality.""",1275.79,1297.32
026_052,026,52,2,is the solution the same do you need to accept the reality of your work environment and who you're working with and what they're going through yeah i think you're right i think the same the same solution applies to me probably reduce my own medicine in that regard,"Therapist: ""So I have to accept my reality.""
Patient: ""and move forward? Except for what it is. This is real. Racism is real. Poverty is real. You hear my mother say, you know, dope fiend, and she's in jail. This is real. But how do I move beyond this now? This is what it is, and I'm realizing it. How do I move beyond this to the next stage of my development?""
Therapist: ""So in a similar way, what you're dealing with from your position""",1305.42,1328.48
026_054,026,54,2,"That's a good question. What could I say at that moment? To alter my thinking. Talking about the kid, not me. Talking about the kid.","Therapist: ""So in a similar way, what you're dealing with from your position""
Patient: ""is the solution the same do you need to accept the reality of your work environment and who you're working with and what they're going through yeah i think you're right i think the same the same solution applies to me probably reduce my own medicine in that regard""
Therapist: ""So let's look at these thoughts, and I want to give you something to work on between this session and next session. Specifically, I want to really go after the micro level at this moment when you're with the youth and they tell you something that's kind of triggering that automatic thought, generally saying, you know, hope is lost. It's a kind of self-defeating thought. What's a thought that you could consciously think, like self-talk, that you could introduce at that moment, in that automatic thought of, it's hopeless? Just to simplify it, it's hopeless. What could you say to yourself at that moment to challenge that thought?""",1387.18,1415.95
026_055,026,55,3,"God makes no mistakes. God makes no mistakes. So it has to be one, there has to be a redeemable quality in this human being sitting in front of me. It just has to be. I'm just not looking. I'm not looking closely. But there has to be some characteristic in this kid that I can find, that I can build on.","Patient: ""is the solution the same do you need to accept the reality of your work environment and who you're working with and what they're going through yeah i think you're right i think the same the same solution applies to me probably reduce my own medicine in that regard""
Therapist: ""So let's look at these thoughts, and I want to give you something to work on between this session and next session. Specifically, I want to really go after the micro level at this moment when you're with the youth and they tell you something that's kind of triggering that automatic thought, generally saying, you know, hope is lost. It's a kind of self-defeating thought. What's a thought that you could consciously think, like self-talk, that you could introduce at that moment, in that automatic thought of, it's hopeless? Just to simplify it, it's hopeless. What could you say to yourself at that moment to challenge that thought?""
Patient: ""That's a good question. What could I say at that moment? To alter my thinking. Talking about the kid, not me. Talking about the kid.""",1426.73,1449.44
026_057,026,57,2,Yeah. That may not look like what I think it should. It may not mean this kid ends up at Howard University on a full ride. Maybe it just means the kid doesn't go to jail. Maybe he starts smoking weed for 24 hours. Maybe I need to manage my expectations a little bit better than I had before.,"Patient: ""That's a good question. What could I say at that moment? To alter my thinking. Talking about the kid, not me. Talking about the kid.""
Patient: ""God makes no mistakes. God makes no mistakes. So it has to be one, there has to be a redeemable quality in this human being sitting in front of me. It just has to be. I'm just not looking. I'm not looking closely. But there has to be some characteristic in this kid that I can find, that I can build on.""
Therapist: ""So you think to yourself, you have a few things there. So you think to yourself, I can see their point of view, In a way, it's really hopeless. But there's got to be a way. Something. There's got to be something in them that you can latch on to.""",1468.72,1494.09
026_059,026,59,2,"I think it would brighten my mood a little bit in terms of my disposition. I think it would brighten it a little bit. I think I'd be a little bit more charismatic about the job than I have been. Because you're right, I have noticed just a thought process that just puts me into a funk. before lunchtime. So, maybe this is that. That would have interrupted the whole process.","Therapist: ""So you think to yourself, you have a few things there. So you think to yourself, I can see their point of view, In a way, it's really hopeless. But there's got to be a way. Something. There's got to be something in them that you can latch on to.""
Patient: ""Yeah. That may not look like what I think it should. It may not mean this kid ends up at Howard University on a full ride. Maybe it just means the kid doesn't go to jail. Maybe he starts smoking weed for 24 hours. Maybe I need to manage my expectations a little bit better than I had before.""
Therapist: ""Okay, so set some goals that you feel are realistic. Yeah. All right. So think about, you have that thought, if I can see their point of view, I can see where they think it's hopeless, maybe it's hopeless, and then you have this adaptive response of there's something in there that's redeemable. Right. How do you think that could change your reaction to that automatic thought?""",1519.6,1558.93
027_004,027,4,4,"I just keep thinking about, you know, losing this weight and I just, I really want to do it and I just, I just can't get there and I don't know why.","Therapist: ""Hello, Kathy. How are you doing today? Okay. You okay? I know when we spoke last time, you had some goals that you want to talk about this time. Are you ready to do that?""
Patient: ""I need to, yeah. Yeah?""
Therapist: ""What do you have in mind?""",43.3,55.01
027_006,027,6,4,"I would like 20 pounds. 20 pounds. I mean, I would like more, but I've tried to do more in the past, and I don't even get past a couple of days. So if I can do 20, that would be great.","Therapist: ""What do you have in mind?""
Patient: ""I just keep thinking about, you know, losing this weight and I just, I really want to do it and I just, I just can't get there and I don't know why.""
Therapist: ""So you're frustrated. It's so ridiculous, yeah. Frustrated trying to lose the weight. Now you had said before that you had a specific number of pounds in mind, specific amount of weight to lose. Do you still have that in mind?""",70.88,82.83
027_008,027,8,2,"I don't know. I guess it wasn't convenient, you know? I want to do it, and it means a lot, you know, for me and my family. I think I'd be a lot healthier.","Therapist: ""So you're frustrated. It's so ridiculous, yeah. Frustrated trying to lose the weight. Now you had said before that you had a specific number of pounds in mind, specific amount of weight to lose. Do you still have that in mind?""
Patient: ""I would like 20 pounds. 20 pounds. I mean, I would like more, but I've tried to do more in the past, and I don't even get past a couple of days. So if I can do 20, that would be great.""
Therapist: ""Right. And you've tried before? And what do you think got in the way?""",92.54,106.67
027_010,027,10,4,"Yeah. But just, like, something always gets in the way, you know, and then I lose focus. I'm not very good at staying focused on stuff like that anyway, so... Alright, so loss of focus.","Therapist: ""Right. And you've tried before? And what do you think got in the way?""
Patient: ""I don't know. I guess it wasn't convenient, you know? I want to do it, and it means a lot, you know, for me and my family. I think I'd be a lot healthier.""
Therapist: ""It's important to you?""",108.05,120.96
027_012,027,12,4,"And I forget, and then I make spaghetti casserole for six people, and then I eat a lot of it, and that's carbs and cheese and fat. And then I will eat what my kids don't eat, and then it's just like I forget that I'm supposed to be making healthy choices.","Therapist: ""It's important to you?""
Patient: ""Yeah. But just, like, something always gets in the way, you know, and then I lose focus. I'm not very good at staying focused on stuff like that anyway, so... Alright, so loss of focus.""
Therapist: ""So you start trying to lose the weight, and your focus gets disrupted.""",126.89,143.87
027_014,027,14,4,Yeah.,"Therapist: ""So you start trying to lose the weight, and your focus gets disrupted.""
Patient: ""And I forget, and then I make spaghetti casserole for six people, and then I eat a lot of it, and that's carbs and cheese and fat. And then I will eat what my kids don't eat, and then it's just like I forget that I'm supposed to be making healthy choices.""
Therapist: ""All right, so you know how to lose weight, and you know you can lose weight, but you Your focus is a little off when you're trying, and that's causing the problem. I think so.""",159.56,162.5
027_016,027,16,2,"Do you think? Well, maybe. Yeah, because I always just keep the chunk of weight ahead of me. I don't break it into smaller increments. It's in my work. I don't know how I'd have to stay on top of it, though, weighing myself every day.","Therapist: ""All right, so you know how to lose weight, and you know you can lose weight, but you Your focus is a little off when you're trying, and that's causing the problem. I think so.""
Patient: ""Yeah.""
Therapist: ""Could we break that goal of losing 20 pounds down into smaller units, like, say, 5 pounds?""",174.73,196.88
027_018,027,18,4,I'm so busy. I don't know.,"Therapist: ""Could we break that goal of losing 20 pounds down into smaller units, like, say, 5 pounds?""
Patient: ""Do you think? Well, maybe. Yeah, because I always just keep the chunk of weight ahead of me. I don't break it into smaller increments. It's in my work. I don't know how I'd have to stay on top of it, though, weighing myself every day.""
Therapist: ""Is that something you can do?""",202.85,205.24
027_020,027,20,2,I'd probably do once a week. Put a sticky note somewhere or something. Maybe. I want to try. I'm going to say yes because I want to try it.,"Therapist: ""Is that something you can do?""
Patient: ""I'm so busy. I don't know.""
Therapist: ""Or once a week?""",208.73,219.36
027_022,027,22,2,"Right now, yes. I think I would need... something to keep me going, you know, week to week.","Therapist: ""Or once a week?""
Patient: ""I'd probably do once a week. Put a sticky note somewhere or something. Maybe. I want to try. I'm going to say yes because I want to try it.""
Therapist: ""So you mentioned the loss of focus is one problem. How about motivation? Do you feel motivated to move through all those steps like five pounds and five pounds and so on?""",234.03,241.04
027_024,027,24,1,"Yeah, like when you're, sometimes when, you know, your kid does your homework early or does their homework early and you can, you know, give them a special treat for dessert, like that helps, you know, keep it going. Okay.","Therapist: ""So you mentioned the loss of focus is one problem. How about motivation? Do you feel motivated to move through all those steps like five pounds and five pounds and so on?""
Patient: ""Right now, yes. I think I would need... something to keep me going, you know, week to week.""
Therapist: ""A little bit of that, something extra to help you stay motivated.""",246.27,257.96
027_026,027,26,2,"Right, right. Yeah. I would love... I mean, I'm just... I've been so embarrassed, you know, lately, so I feel like... I just... If I can find something that keeps me motivated, that would be great.","Therapist: ""A little bit of that, something extra to help you stay motivated.""
Patient: ""Yeah, like when you're, sometimes when, you know, your kid does your homework early or does their homework early and you can, you know, give them a special treat for dessert, like that helps, you know, keep it going. Okay.""
Therapist: ""So some sort of activity or item that you enjoy that you could reserve for when you reach that goal of, say, the first five pounds.""",276.75,293.93
027_030,027,30,2,"maybe something every day. So I remember, you know, I just get so distracted by other stuff. So there was something every day that maybe I put, put out almost like a, like a goal at the end of the day or something. Okay. You know, if I've made the right choices.","Therapist: ""All right. Do you have a... activity or item in mind that we could put in place as something you could reward yourself with?""
Patient: ""Like after the first five pounds?""
Therapist: ""Well, there's a few ways we could do it. We could do that so you reach five pounds and then you can give yourself that reward. Reward could be for something you do every day if that day you're successful in eating the way you want to eat. What do you think would motivate you more?""",328.0,346.1
027_034,027,34,3,"Right. And that could be, you know, maybe watching like a favorite TV show. Okay. You know, because I don't watch TV at night because I'm so busy. you know, cleaning up and everything. Maybe I could just take some time for myself because I did something good, you know, and just watch a TV show.","Therapist: ""Yes. So, you know, each and every day as you're trying to lose weight, you're aware of when that day comes to a close, if you had a successful day or a less than successful day.""
Patient: ""Right.""
Therapist: ""And if you have a successful day, then you could engage in an activity or receive an item that we work out in advance that you know would motivate you.""",369.7,389.76
027_036,027,36,2,"Probably as I'm preparing dinner. If I prepare a good dinner... Or if I prepare fun food for my kids, but I don't eat it, like chicken nuggets and french fries and stuff, I would know, you know, maybe by like 6 or 7 in the evening. Okay, let's say 7.","Therapist: ""And if you have a successful day, then you could engage in an activity or receive an item that we work out in advance that you know would motivate you.""
Patient: ""Right. And that could be, you know, maybe watching like a favorite TV show. Okay. You know, because I don't watch TV at night because I'm so busy. you know, cleaning up and everything. Maybe I could just take some time for myself because I did something good, you know, and just watch a TV show.""
Therapist: ""All right. So let's do that. On a day, you know, toward the evening, when you know you have had a successful day, by what time would you know in the evening?""",404.34,422.89
027_038,027,38,2,"I don't know, honestly, but it would probably beat the way I feel right now. Anything's kind of better than carrying this frustration around. So I'm willing to try anything. And I'll try to remember. Like I said, I'll write it down. I'll have it in the kitchen. have it on a note, 7 p.m., you know, how did I do today?","Therapist: ""All right. So let's do that. On a day, you know, toward the evening, when you know you have had a successful day, by what time would you know in the evening?""
Patient: ""Probably as I'm preparing dinner. If I prepare a good dinner... Or if I prepare fun food for my kids, but I don't eat it, like chicken nuggets and french fries and stuff, I would know, you know, maybe by like 6 or 7 in the evening. Okay, let's say 7.""
Therapist: ""Okay. So by 7 p.m., at that point, in terms of the day being successful or less than successful, you know. Okay. By 7 p.m., you're aware. And at that point, if you have... met your goal then you have a tv show that you maybe recorded on the dvr or something you would watch okay and if you were not as successful you wouldn't right so it'd be like something to keep you motivated throughout the day because you really want to watch that show right it'd be a lot of fun do you think that structure that kind of behavioral strategy would would give you enough motivation to have successful days through this process?""",476.45,503.19
027_040,027,40,1,"Yeah, I didn't think about that because, right, every day would be different. Okay.","Therapist: ""Okay. So by 7 p.m., at that point, in terms of the day being successful or less than successful, you know. Okay. By 7 p.m., you're aware. And at that point, if you have... met your goal then you have a tv show that you maybe recorded on the dvr or something you would watch okay and if you were not as successful you wouldn't right so it'd be like something to keep you motivated throughout the day because you really want to watch that show right it'd be a lot of fun do you think that structure that kind of behavioral strategy would would give you enough motivation to have successful days through this process?""
Patient: ""I don't know, honestly, but it would probably beat the way I feel right now. Anything's kind of better than carrying this frustration around. So I'm willing to try anything. And I'll try to remember. Like I said, I'll write it down. I'll have it in the kitchen. have it on a note, 7 p.m., you know, how did I do today?""
Therapist: ""Yeah, this is something you could also track, right? You could write down days that were successful, days that were less than successful, and we could look at if there's any patterns. Maybe weekends are harder, weekends are easier, you know, or something where we can identify days that have maybe more triggers or where you're less motivated.""",523.24,527.4
027_042,027,42,4,So that's leading up to the five pounds.,"Therapist: ""Yeah, this is something you could also track, right? You could write down days that were successful, days that were less than successful, and we could look at if there's any patterns. Maybe weekends are harder, weekends are easier, you know, or something where we can identify days that have maybe more triggers or where you're less motivated.""
Patient: ""Yeah, I didn't think about that because, right, every day would be different. Okay.""
Therapist: ""There's a potential for every day to be different with what you're exposed to and what temptations in terms of different foods or what your schedule's like. Maybe if you're busier, it's easier. So we can look at those different patterns, and we can add levels to this plan. Okay. But for now, we'll go with the TV show that you'll watch sometime after 7. So at 7, you'll evaluate how you did, and then sometime after that, Watch the show. Okay. That's like a plan?""",559.77,562.1
027_046,027,46,2,Okay. Yeah.,"Therapist: ""Right.""
Patient: ""Right, okay. That's just day by day. Okay.""
Therapist: ""Take this in five pound increments. Okay. Four times to get to your goal of 20 pounds.""",570.93,574.67
027_048,027,48,1,So I could start tonight? Start tonight. Okay. All right.,"Therapist: ""Take this in five pound increments. Okay. Four times to get to your goal of 20 pounds.""
Patient: ""Okay. Yeah.""
Therapist: ""Does that sound good? So far so good, yeah. We'll give that a shot and we'll take a look at the pattern that emerges. So record everything. So write everything down. Okay. Probably at around 7 is a good time when you know what kind of day you had. Write down kind of what happened that day and whether you had success or not and bring that in. I'll see you again in a week. That will give you seven days to work with. Okay. And we'll look at that log of events and reevaluate each week.""",609.05,613.46
028_000,028,0,2,I hate the way you're doing today.,(Beginning of session — no prior context),14.5,17.98
028_002,028,2,2,"What's going on? Well, remember I had told you that they were downsizing at my job?","Patient: ""I hate the way you're doing today.""
Therapist: ""No. Not well? No.""",20.9,26.41
028_004,028,4,4,"So, I've been there 20 years at my job. A long time. Yeah, and they're downsizing lately and they let me go.","Therapist: ""No. Not well? No.""
Patient: ""What's going on? Well, remember I had told you that they were downsizing at my job?""
Therapist: ""I remember that.""",28.25,39.04
028_006,028,6,4,"No. No? No. So, yeah, it's just, you know, they let me go. I have really nothing to go on. I don't know what to do. I've been at that job so long. I really, you know, don't know how to do anything else.","Therapist: ""I remember that.""
Patient: ""So, I've been there 20 years at my job. A long time. Yeah, and they're downsizing lately and they let me go.""
Therapist: ""Well, that's terrible. I'm sorry to hear that. Do you have, like, any type of severance or anything like that?""",49.61,62.95
028_008,028,8,4,"Yeah, I was. I thought, you know, I envisioned doing that job forever, for a long time, so...","Therapist: ""Well, that's terrible. I'm sorry to hear that. Do you have, like, any type of severance or anything like that?""
Patient: ""No. No? No. So, yeah, it's just, you know, they let me go. I have really nothing to go on. I don't know what to do. I've been at that job so long. I really, you know, don't know how to do anything else.""
Therapist: ""You used to talk about that job. You were happy there.""",66.33,74.82
028_010,028,10,5,"Oh, it's awful. I mean, we definitely, my husband and I, it's really spiraled out of control. My husband and I have kind of like joint, we pay the bills together and so this was half of our income and that's gone. And because it was kind of More sudden, we didn't really have time to do anything else. You know, time to prepare.","Therapist: ""You used to talk about that job. You were happy there.""
Patient: ""Yeah, I was. I thought, you know, I envisioned doing that job forever, for a long time, so...""
Therapist: ""And that's not going to happen now. No. How does this affect your financial outlook, like your bills and such?""",84.76,106.5
028_014,028,14,2,"Yeah, so far. But if I don't find a job soon, then I don't know what's going to happen. I don't know how bad it's going to get.","Therapist: ""So it definitely caught you off guard. Do you have enough income with your husband's job to cover your basic bills?""
Patient: ""We're a little bit behind.""
Therapist: ""A little bit behind.""",118.93,126.4
028_016,028,16,2,"My husband usually does deals with the bills, so I'm not quite sure. But probably in another month or so, it's going to get really bad.","Therapist: ""A little bit behind.""
Patient: ""Yeah, so far. But if I don't find a job soon, then I don't know what's going to happen. I don't know how bad it's going to get.""
Therapist: ""Do you know about how long you have for... You failed to meet any financial commitments?""",134.43,142.94
028_020,028,20,5,"All sorts. I mean, I worry that... My husband and I are arguing because we're under all the stress. I worry we're going to lose our house. I'm worried I'm going to be homeless. It's embarrassing. I don't have a job now. What if I don't find another job? What are my kids going to do? My kids are relying on us to meet their needs. They depend on you. Yeah. We could be homeless. I might not ever get a job again. I'm not getting any younger. So I'm afraid that I won't get another job.","Therapist: ""It's about a month.""
Patient: ""Yeah.""
Therapist: ""What thoughts have you been having?""",153.81,193.75
028_022,028,22,2,I'm not sure. I'm still looking into that.,"Therapist: ""What thoughts have you been having?""
Patient: ""All sorts. I mean, I worry that... My husband and I are arguing because we're under all the stress. I worry we're going to lose our house. I'm worried I'm going to be homeless. It's embarrassing. I don't have a job now. What if I don't find another job? What are my kids going to do? My kids are relying on us to meet their needs. They depend on you. Yeah. We could be homeless. I might not ever get a job again. I'm not getting any younger. So I'm afraid that I won't get another job.""
Therapist: ""Now, you said you were laid off, right? Yeah. From the position. Are you eligible for unemployment?""",202.92,204.94
028_034,028,34,1,Not that I know of.,"Therapist: ""That's more like an identity thing, right? So you identify with what you did.""
Patient: ""Right.""
Therapist: ""And now you don't as much because you're not actively working on it. Yeah. Did you ever have any coworkers who voluntarily left for other jobs?""",267.47,270.17
028_036,028,36,1,"Not that I was aware of, I don't think. Maybe like one a while ago, but it was a pretty good job.","Therapist: ""And now you don't as much because you're not actively working on it. Yeah. Did you ever have any coworkers who voluntarily left for other jobs?""
Patient: ""Not that I know of.""
Therapist: ""Not at the time you worked there?""",271.83,276.2
028_038,028,38,3,Yeah.,"Therapist: ""Not at the time you worked there?""
Patient: ""Not that I was aware of, I don't think. Maybe like one a while ago, but it was a pretty good job.""
Therapist: ""So a lot of people stayed?""",278.04,280.1
028_040,028,40,1,"Yeah, one of my friends was in a similar field and left the job and eventually found another job.","Therapist: ""So a lot of people stayed?""
Patient: ""Yeah.""
Therapist: ""Have you ever known anybody who worked for a similar company or in the same field who changed jobs?""",287.79,294.44
028_042,028,42,2,It took a while. It took a while. Maybe like two years or so at least. A long while. Yeah. It was a struggle for their family. So I think about that.,"Therapist: ""Have you ever known anybody who worked for a similar company or in the same field who changed jobs?""
Patient: ""Yeah, one of my friends was in a similar field and left the job and eventually found another job.""
Therapist: ""How long it took him?""",296.43,305.76
028_044,028,44,2,"I mean, probably part of it. Maybe... Full would be ideal because we were comfortable the way we were living. So full would be ideal. But we could probably survive on part of it. It's just not as well as we were living.","Therapist: ""How long it took him?""
Patient: ""It took a while. It took a while. Maybe like two years or so at least. A long while. Yeah. It was a struggle for their family. So I think about that.""
Therapist: ""Would you need to replace that full income to pay your bills or part of that income?""",315.07,334.13
028_046,028,46,2,"I mean, I've been trying. to think of different opportunities that might be open to me now and being able to spend more time with my kids and things like that. I've been trying to think of it other ways, my situation.","Therapist: ""Would you need to replace that full income to pay your bills or part of that income?""
Patient: ""I mean, probably part of it. Maybe... Full would be ideal because we were comfortable the way we were living. So full would be ideal. But we could probably survive on part of it. It's just not as well as we were living.""
Therapist: ""So we've talked about problem solving skills before in earlier sessions. So have you applied any of those concepts to what's going on now?""",346.01,365.4
028_048,028,48,4,"I've thought about it, but I'm really having a hard time with it.","Therapist: ""So we've talked about problem solving skills before in earlier sessions. So have you applied any of those concepts to what's going on now?""
Patient: ""I mean, I've been trying. to think of different opportunities that might be open to me now and being able to spend more time with my kids and things like that. I've been trying to think of it other ways, my situation.""
Therapist: ""So there's an upside in that sense, the time part. At some point, you need to replace the income. It's very pragmatic. You need the money. Have you considered that if you attempted to seek a full-time job, it didn't work out, you could look at part-time jobs?""",385.57,388.23
028_050,028,50,2,"what would it mean about me? That I think if I only had a part-time job that I wasn't qualified, that I wasn't good enough for a full-time job.","Therapist: ""So there's an upside in that sense, the time part. At some point, you need to replace the income. It's very pragmatic. You need the money. Have you considered that if you attempted to seek a full-time job, it didn't work out, you could look at part-time jobs?""
Patient: ""I've thought about it, but I'm really having a hard time with it.""
Therapist: ""What would it mean about you? What would it say about you if you had to take a part-time job instead of finding another full-time job that's so much of the one you lost?""",401.17,416.45
028_052,028,52,5,"Well, right now it's not going well. I mean, I've been arguing with my husband. I've been drinking a lot more. You know, the depression has come back a lot worse. So it's just starting to become this cycle where, you know, I'm drinking and getting into arguments, and the situation's not getting better, and it just keeps snowballing.","Therapist: ""What would it mean about you? What would it say about you if you had to take a part-time job instead of finding another full-time job that's so much of the one you lost?""
Patient: ""what would it mean about me? That I think if I only had a part-time job that I wasn't qualified, that I wasn't good enough for a full-time job.""
Therapist: ""So you would internalize that and the meaning would be that you're not as valuable? Yeah. So it speaks to self-worth. That kind of thinking we've talked about before in other situations can impede you trying to meet your goal. So what do you do when you're feeling not worthy, when you're feeling worthless? What do you do?""",452.69,471.76
028_058,028,58,4,But it's hard when I'm really depressed and the situation's not getting better and I'm just home sitting about drinking while everyone else is carrying on with their life and I'm stuck here.,"Therapist: ""That ends up in more dysfunction, right? With the relationship with your husband.""
Patient: ""Yeah.""
Therapist: ""I imagine if you're intoxicated, you're not looking for new work. Yeah. Right? That wouldn't be ideal timing. In a sense, you're not helping things to improve. And it all kind of starts with that thinking.""",519.16,531.05
028_060,028,60,4,"No, I know it's not helping.","Therapist: ""I imagine if you're intoxicated, you're not looking for new work. Yeah. Right? That wouldn't be ideal timing. In a sense, you're not helping things to improve. And it all kind of starts with that thinking.""
Patient: ""But it's hard when I'm really depressed and the situation's not getting better and I'm just home sitting about drinking while everyone else is carrying on with their life and I'm stuck here.""
Therapist: ""Right. And that ties into that kind of worthless type thought, right? So you're fulfilling that role. of being worthless. That's how it's manifesting for you. And that's one thing you can do. That's an option. You can drink and you can have relational struggles. But is that really what you want out of all this? Is that the most useful?""",560.58,564.26
028_062,028,62,2,"I've been thinking about trying to get more organized, like we talked about before with the finances, and trying to figure out exactly how much income we need to be where we want, but to do it in maybe baby steps so it's not so overwhelming for me, like this thought of getting a new job and making enough money and providing for my family. It's kind of like breaking it down.","Therapist: ""Right. And that ties into that kind of worthless type thought, right? So you're fulfilling that role. of being worthless. That's how it's manifesting for you. And that's one thing you can do. That's an option. You can drink and you can have relational struggles. But is that really what you want out of all this? Is that the most useful?""
Patient: ""No, I know it's not helping.""
Therapist: ""How do you think you could break that cycle?""",568.32,595.35
028_066,028,66,4,"I think just sometimes like the fear of the unknown, like worry about what if this never happens for me? You know, what if I don't get a job? You know, what if we lose our house? What if? That worry's nagging.","Therapist: ""Well, that makes sense. Yeah, so your first step would be figuring out what's the minimum amount you really need. Right. So you'll shoot for hire. You'll go for it full time, but you realize that you kind of need to know what the minimum is because you know what job offer you could accept and what job offer you'd have to decline. Right. So that makes sense. So armed with that information, then you could go out to the workplace.""
Patient: ""Right.""
Therapist: ""And maybe with a little less anxiety, Kind of just know this job is going to, if I get it, it's good. Right. Or I might as well not apply to this one because it's not going to work. So it's efficient. It's time-saving. It's good. That sounds logical. What do you think could get in the way of those steps? What obstacles are you seeing?""",641.97,657.97
028_070,028,70,2,"I mean... Worst case, if we don't get a job, I mean, we would probably, I don't know, like get a smaller house or find a way around it. I mean, we've been through some tough times.","Therapist: ""The what if? Yeah, that worry's nagging, yeah.""
Patient: ""Yeah.""
Therapist: ""Yeah. So I think it's pretty likely that with a bachelor's degree and the background we've talked about in other sessions that you'll get a job. Let's go with the scenario that you don't. With the understanding that's a pretty low probability event. Let's just say, okay, what happens then? Say you never find another job. That's the worst case. We would agree that's the worst case. Yeah, it's pretty awful. That's pretty awful. That's the worst case scenario. It can't get any worse than that. What would happen?""",696.3,708.96
028_072,028,72,2,"So like it would be difficult, but I think if I really thought about it, you know, we would probably get through it.","Therapist: ""Yeah. So I think it's pretty likely that with a bachelor's degree and the background we've talked about in other sessions that you'll get a job. Let's go with the scenario that you don't. With the understanding that's a pretty low probability event. Let's just say, okay, what happens then? Say you never find another job. That's the worst case. We would agree that's the worst case. Yeah, it's pretty awful. That's pretty awful. That's the worst case scenario. It can't get any worse than that. What would happen?""
Patient: ""I mean... Worst case, if we don't get a job, I mean, we would probably, I don't know, like get a smaller house or find a way around it. I mean, we've been through some tough times.""
Therapist: ""It would be difficult, right? To be fair, right? It would be difficult, but you would adapt. Right.""",714.22,720.01
028_074,028,74,1,"I mean, I think when I really think about it, you know, like you said, I think I'm less depressed or think that I, you know, I'm more able to cope with it, you know, knowing, okay, well, this is the worst that could happen, but maybe it's not as bad as I thought it would be in my head.","Therapist: ""It would be difficult, right? To be fair, right? It would be difficult, but you would adapt. Right.""
Patient: ""So like it would be difficult, but I think if I really thought about it, you know, we would probably get through it.""
Therapist: ""So if we pick up with that, if we say, that's really an adaptive response. Remember we talked about adaptive responses to automatic thoughts, right? So if you're telling yourself that you have the depression and certainly anxiety, the craving to drink, you tell yourself, well, the worst that could happen is I don't work for the rest of my life. Again, acknowledging that's pretty unlikely. But the worst that could happen is I won't work again. And I might have to adapt, I might have to have a simpler life in terms of material goods and a smaller house, but I would survive. What effect might that have on your mood or your thoughts?""",764.29,782.37
028_076,028,76,1,Does that make sense?,"Therapist: ""So if we pick up with that, if we say, that's really an adaptive response. Remember we talked about adaptive responses to automatic thoughts, right? So if you're telling yourself that you have the depression and certainly anxiety, the craving to drink, you tell yourself, well, the worst that could happen is I don't work for the rest of my life. Again, acknowledging that's pretty unlikely. But the worst that could happen is I won't work again. And I might have to adapt, I might have to have a simpler life in terms of material goods and a smaller house, but I would survive. What effect might that have on your mood or your thoughts?""
Patient: ""I mean, I think when I really think about it, you know, like you said, I think I'm less depressed or think that I, you know, I'm more able to cope with it, you know, knowing, okay, well, this is the worst that could happen, but maybe it's not as bad as I thought it would be in my head.""
Therapist: ""So there's a piece that comes with clarity that comes with accepting what the worst case scenario could be. Right. And probably another part of the adaptive response could be, you know, I could live through the worst case scenario, I think it's important to acknowledge that it's unlikely. That's still unlikely. So statistics, probability is on your side here. Right. So as you go out into the workplace and the workforce and seek employment, you'll probably have some interviews where you don't get job offers. But eventually you'll probably have one where you do. Yeah. It's just math. Right. If you can accept the worst case, that maybe reduce or eliminate that alcohol consumption, maybe reduce that depression, reduce that anxiety.""",835.59,838.91
029_007,029,7,4,"Yeah. I've been sleeping a lot. Going to work is a struggle. I don't really ever want to go. Mm-hmm. I haven't been eating much, so... Mm-hmm. I think I've lost like 10 pounds since the past like four months or so.","Therapist: ""Yeah. Not sure?""
Patient: ""I don't know. It's just the same.""
Therapist: ""Yeah? Still a little down?""",28.64,50.18
029_009,029,9,4,"Just like I don't know, I just haven't really been doing anything.","Therapist: ""Yeah? Still a little down?""
Patient: ""Yeah. I've been sleeping a lot. Going to work is a struggle. I don't really ever want to go. Mm-hmm. I haven't been eating much, so... Mm-hmm. I think I've lost like 10 pounds since the past like four months or so.""
Therapist: ""The past four months?""",55.42,60.65
029_013,029,13,4,"No, I usually just go to work and go home.","Therapist: ""You've still been working?""
Patient: ""Well, yeah.""
Therapist: ""Yeah, but not much else?""",67.8,71.1
029_015,029,15,2,"Well, my fiancé tries to talk to me and really I just kind of want to go to sleep or just, I don't know. I tried reading the other day because I used to like that and it's just, I think I got like into two pages and put the book down and decided to go to bed.","Therapist: ""Yeah, but not much else?""
Patient: ""No, I usually just go to work and go home.""
Therapist: ""Tell me what happens after you. arriving home, like after work?""",79.06,96.57
029_017,029,17,3,Just that I wasn't really happy doing it I didn't really get any enjoyment out of it.,"Therapist: ""Tell me what happens after you. arriving home, like after work?""
Patient: ""Well, my fiancé tries to talk to me and really I just kind of want to go to sleep or just, I don't know. I tried reading the other day because I used to like that and it's just, I think I got like into two pages and put the book down and decided to go to bed.""
Therapist: ""What were you thinking when you put the book down?""",101.11,106.53
029_021,029,21,2,"Oh, I used to fall asleep reading. I would be up until like 2 in the morning just reading a book.","Therapist: ""And before you were depressed, which is, I guess, about eight months now, you did enjoy reading.""
Patient: ""Mm-hmm. Oh, yeah, all the time.""
Therapist: ""So what would you have thought if you had to put a book down back then?""",125.22,131.05
029_023,029,23,2,Yeah. Yeah.,"Therapist: ""So what would you have thought if you had to put a book down back then?""
Patient: ""Oh, I used to fall asleep reading. I would be up until like 2 in the morning just reading a book.""
Therapist: ""Something you look forward to?""",132.87,135.16
029_025,029,25,2,"No, I just didn't really get any. I just wanted to try it and then I put it back down.","Therapist: ""Something you look forward to?""
Patient: ""Yeah. Yeah.""
Therapist: ""But not now?""",137.08,144.43
029_027,029,27,4,"Yeah, I used to be a runner. And then I tried going for a run the other morning with my dog, and I think we walked a block, and that was pretty much it. I just couldn't wait for it to be over.","Therapist: ""But not now?""
Patient: ""No, I just didn't really get any. I just wanted to try it and then I put it back down.""
Therapist: ""Were there other things that you used to enjoy doing that you don't feel motivated or comfortable to do now?""",156.8,173.3
029_029,029,29,2,"Not really. I mean, it was the change to be outdoors, and I realized I hadn't really seen the sun in a while. All right. But other than that, I had the intention of going out to run. I had my running shoes on, and my dog was really excited. And then by the time I got out there, I was like, yeah, we're going to walk. And then I thought about walking our normal route, and by the time I got to the corner, I was like, yeah, we're going to turn around and walk back.","Therapist: ""Were there other things that you used to enjoy doing that you don't feel motivated or comfortable to do now?""
Patient: ""Yeah, I used to be a runner. And then I tried going for a run the other morning with my dog, and I think we walked a block, and that was pretty much it. I just couldn't wait for it to be over.""
Therapist: ""All right, so it wasn't a pleasant experience. Was there any part of it you connected with when you were running, like when you first started?""",184.55,212.7
029_031,029,31,2,Kind of a mix of like relief just because it was over and then I guess more sadness because I didn't do anything. I didn't do what I had intended to do.,"Therapist: ""All right, so it wasn't a pleasant experience. Was there any part of it you connected with when you were running, like when you first started?""
Patient: ""Not really. I mean, it was the change to be outdoors, and I realized I hadn't really seen the sun in a while. All right. But other than that, I had the intention of going out to run. I had my running shoes on, and my dog was really excited. And then by the time I got out there, I was like, yeah, we're going to walk. And then I thought about walking our normal route, and by the time I got to the corner, I was like, yeah, we're going to turn around and walk back.""
Therapist: ""So what was the feeling like when you returned to your home after planning to run and then kind of walking and coming back?""",224.46,236.88
029_035,029,35,2,"Yeah, I guess you could say that.","Therapist: ""Sadness, maybe disappointment?""
Patient: ""Yeah.""
Therapist: ""Yeah. So, I've seen you a few times now and Based on those conversations and of course what you've said today, it seems like you have, for a variety of reasons, given up on the activities that you used to enjoy. You're not motivated toward them anymore.""",266.39,270.46
029_037,029,37,2,"It does, yeah.","Therapist: ""Yeah. So, I've seen you a few times now and Based on those conversations and of course what you've said today, it seems like you have, for a variety of reasons, given up on the activities that you used to enjoy. You're not motivated toward them anymore.""
Patient: ""Yeah, I guess you could say that.""
Therapist: ""And that's a common symptom of depression. I think we've talked about this a little bit before. So it's tough when you're depressed to find joy, satisfaction, happiness in activities that you once enjoyed. So we've been working with the cognitive piece, right, like we did last time where we talked about the automatic thoughts that come up and kind of how that leads to some of the feelings of sadness and what we can do with the self-talk. But I'd like to talk about a different technique today that approaches the problem from a different angle. We'll continue to work the cognitive angle, but I want to add a new angle. And the technique is called behavioral activation. So, the theory behind it is that if you engage If you schedule and engage in activities that you once enjoyed, even if you kind of have to fight your way through it a little bit, like with the running, that will connect to your mood. Remember, we believe in cognitive therapy that affect and behavior and cognition are all connected. So what you're thinking affects your behavior and your mood, and what you do, your behavior, affects your thinking and your mood. Does that kind of make sense based on what we talked about?""",361.94,364.88
029_039,029,39,2,"Well, my fiance and I used to go out with two other couples, and we used to go out once or twice a week, and even if it's just each other's houses, but we haven't really seen them in a while. They've tried to schedule things, but I've kind of come up with reasons of not feeling well or to kind of just stay home.","Therapist: ""And that's a common symptom of depression. I think we've talked about this a little bit before. So it's tough when you're depressed to find joy, satisfaction, happiness in activities that you once enjoyed. So we've been working with the cognitive piece, right, like we did last time where we talked about the automatic thoughts that come up and kind of how that leads to some of the feelings of sadness and what we can do with the self-talk. But I'd like to talk about a different technique today that approaches the problem from a different angle. We'll continue to work the cognitive angle, but I want to add a new angle. And the technique is called behavioral activation. So, the theory behind it is that if you engage If you schedule and engage in activities that you once enjoyed, even if you kind of have to fight your way through it a little bit, like with the running, that will connect to your mood. Remember, we believe in cognitive therapy that affect and behavior and cognition are all connected. So what you're thinking affects your behavior and your mood, and what you do, your behavior, affects your thinking and your mood. Does that kind of make sense based on what we talked about?""
Patient: ""It does, yeah.""
Therapist: ""So you mentioned the reading was one thing you like to do that's tough to do now. You tried unsuccessfully with the reading and the running. Anything else you could think of that maybe we could plan for you to do, even if it's just a short time, even if it's a little bit uncomfortable, that we could plan to do that would be an activity that you used to enjoy?""",396.13,422.13
029_041,029,41,2,"Yeah, I haven't really wanted to see anybody lately.","Therapist: ""So you mentioned the reading was one thing you like to do that's tough to do now. You tried unsuccessfully with the reading and the running. Anything else you could think of that maybe we could plan for you to do, even if it's just a short time, even if it's a little bit uncomfortable, that we could plan to do that would be an activity that you used to enjoy?""
Patient: ""Well, my fiance and I used to go out with two other couples, and we used to go out once or twice a week, and even if it's just each other's houses, but we haven't really seen them in a while. They've tried to schedule things, but I've kind of come up with reasons of not feeling well or to kind of just stay home.""
Therapist: ""So they're trying to initiate meeting, going out and doing something, and you're kind of pushing them off.""",432.16,435.75
029_043,029,43,2,can't quite motivate yourself to do now I mean I used to like going for like just walks and shopping with my fiance like we used to spend a lot of time together and lately it's just kind of I come home I say hello we eat dinner and then I kind of do my own thing so spending time with your fiance outside the house in some manner,"Therapist: ""So they're trying to initiate meeting, going out and doing something, and you're kind of pushing them off.""
Patient: ""Yeah, I haven't really wanted to see anybody lately.""
Therapist: ""All right, so we have reading, running, and then going out with these two other couples. Anything else you can think of that you used to really enjoy before that you can't?""",450.71,480.13
029_045,029,45,2,"Yeah, I would kind of put those in with the things that we would do outside together. We would try to switch it up every now and then.","Therapist: ""All right, so we have reading, running, and then going out with these two other couples. Anything else you can think of that you used to really enjoy before that you can't?""
Patient: ""can't quite motivate yourself to do now I mean I used to like going for like just walks and shopping with my fiance like we used to spend a lot of time together and lately it's just kind of I come home I say hello we eat dinner and then I kind of do my own thing so spending time with your fiance outside the house in some manner""
Therapist: ""Shopping was one example. Any other activities? Like movies or going out to eat?""",489.69,498.39
029_049,029,49,1,"I like a lot of fiction. I do a lot of reading for school, so I usually enjoy those books too. Mystery novels.","Therapist: ""Okay, so that's distinct from what you do with the couples because that's just you and your fiancé.""
Patient: ""Yes.""
Therapist: ""So let's do this. What kind of books do you like to read?""",509.84,523.31
029_051,029,51,1,"Depending on the size of the chapter, probably a couple minutes normally.","Therapist: ""So let's do this. What kind of books do you like to read?""
Patient: ""I like a lot of fiction. I do a lot of reading for school, so I usually enjoy those books too. Mystery novels.""
Therapist: ""Mystery novels. Okay. Let's center on mystery novels. How long would it take you to read, say, a chapter of a mystery novel, roughly?""",534.78,537.72
029_053,029,53,1,"Um, probably like a half hour, half hour to 45 minutes. Yeah. I used to do long distance running, so.","Therapist: ""Mystery novels. Okay. Let's center on mystery novels. How long would it take you to read, say, a chapter of a mystery novel, roughly?""
Patient: ""Depending on the size of the chapter, probably a couple minutes normally.""
Therapist: ""So not long at all? So you could get a lot of reading done in say 10 minutes. Like something worthwhile. And how often would it, how often would you, what was the duration of a run? Like when you would go and run, how long would it take?""",556.91,565.16
029_055,029,55,1,"I would say try to do something every day, like even if it was just going for a walk together, like around the park or walking the dog together.","Therapist: ""So not long at all? So you could get a lot of reading done in say 10 minutes. Like something worthwhile. And how often would it, how often would you, what was the duration of a run? Like when you would go and run, how long would it take?""
Patient: ""Um, probably like a half hour, half hour to 45 minutes. Yeah. I used to do long distance running, so.""
Therapist: ""Okay. And how often would you do that? Uh, three to four times a week. Three or four times a week. Half hour, 40 minutes. And you mentioned you went out with the couple once or twice a week. How often would you go out with your fiancé?""",579.72,587.25
029_067,029,67,1,Probably the weekends. So probably like Saturday or Friday night or Saturday morning.,"Therapist: ""Okay. How about that twice a week? Would that be possible?""
Patient: ""Yeah, I can try to do that.""
Therapist: ""What days of the week do you think you could do it?""",693.44,700.39
029_069,029,69,2,"No, I guess not. So probably I'd say maybe Wednesday night and Saturday morning.","Therapist: ""What days of the week do you think you could do it?""
Patient: ""Probably the weekends. So probably like Saturday or Friday night or Saturday morning.""
Therapist: ""Okay. So Saturday morning and Friday night. Would you run Friday night and then again Saturday morning?""",707.54,714.15
029_071,029,71,2,"Yeah, he's, I don't know if he's kind of just been mad at me lately or if he just thinks I need to be alone, but we've kind of been getting some distance there. So I think that would, out of everything, that would be the relationship I'd want to work on the most.","Therapist: ""Okay. So Saturday morning and Friday night. Would you run Friday night and then again Saturday morning?""
Patient: ""No, I guess not. So probably I'd say maybe Wednesday night and Saturday morning.""
Therapist: ""Okay. So Wednesday night and Saturday morning. Okay. say a minimum of a half hour. I can try for that, yeah. And again, remember, you're going to have these automatic thoughts likely that will be telling you that you should stop. But you have to kind of talk your way through that. Okay. Or do the best you can. Yeah. All right. The adaptive response maybe being something like, in the end, this will help me. Like, it's tough now, but this will help me. Okay. So let's look now toward the more social aspects. Logistically, moving up the ladder here to the most complex, it sounds like going out with your fiancé would be the next, at the next level.""",758.18,774.14
029_075,029,75,2,"I don't know, I guess... Just having him maybe remind me or suggest it.","Therapist: ""Focus on, all right. So maybe, so you're running Wednesdays and Saturday mornings. Could you go out and do something with your fiancee twice a week?""
Patient: ""Yeah, I think we could manage that.""
Therapist: ""Because sometimes you said you just walk around the neighborhood, so it's not even necessarily a lot of time. It's just something. What do you think you can do to motivate yourself to do that?""",805.85,814.74
029_085,029,85,2,"Just having to actually go to their houses or go somewhere because they don't really live close to us. They're not far, but just the fact that we would have to get in the car, drive over there, and I would actually have to, like, look relatively nice. I can't just go and, like, chill in this.","Therapist: ""Like maybe a Saturday night or a Friday night?""
Patient: ""Yeah, I think that could work.""
Therapist: ""What can you see being an obstacle there? What might help you be motivated to continue that?""",860.55,879.49
029_089,029,89,2,"You have to... Yeah, we physically have to go over.","Therapist: ""So for this to work, that is for you to do it, you really have to schedule at their house. You can't have them come to you.""
Patient: ""Yeah.""
Therapist: ""All right, so that's one thing we know. You have to make some time and drive over there. Or maybe if your fiancé drives, whichever, but.""",897.74,900.9
029_091,029,91,2,"I don't know. If it's, like, the run, I'd probably just want to turn around and come back. I don't know.","Therapist: ""All right, so that's one thing we know. You have to make some time and drive over there. Or maybe if your fiancé drives, whichever, but.""
Patient: ""You have to... Yeah, we physically have to go over.""
Therapist: ""Right. So once you're there, like, so it might be tough, like, to get in the car and make the drive over. Once you're there, how do you think you would feel?""",912.94,919.95
029_093,029,93,4,"I think they've noticed, and I think that's probably why they've kind of started to back off with asking us to do things. So I think they've noticed it, but they don't know like any, they don't know what's really going on. So.","Therapist: ""Right. So once you're there, like, so it might be tough, like, to get in the car and make the drive over. Once you're there, how do you think you would feel?""
Patient: ""I don't know. If it's, like, the run, I'd probably just want to turn around and come back. I don't know.""
Therapist: ""Do these couples know that you're a little down?""",923.96,940.06
029_095,029,95,2,"Yeah. Yeah. I mean, they're our closest friends, so we've known each other for a really long time.","Therapist: ""Do these couples know that you're a little down?""
Patient: ""I think they've noticed, and I think that's probably why they've kind of started to back off with asking us to do things. So I think they've noticed it, but they don't know like any, they don't know what's really going on. So.""
Therapist: ""Are those relationships you're worried about losing because they're backing off?""",948.71,956.36
029_097,029,97,2,"Yeah, I mean, I think it would definitely... Just us going. They might be a little hesitant because the past couple times they've invited us, we've backed out. But I think it would probably be a step in that direction of restoring the relationship. So, I mean, I would like to do that.","Therapist: ""Are those relationships you're worried about losing because they're backing off?""
Patient: ""Yeah. Yeah. I mean, they're our closest friends, so we've known each other for a really long time.""
Therapist: ""And could you see this behavior being one that brings you closer together with them? Like, restore some of that?""",962.55,978.5
029_101,029,101,2,"I think so, yeah. I mean, I can try to get accountability with my fiancé just to let him know my plan and then see if he can help me follow through with it, I guess.","Therapist: ""Okay. So, I want to review the plan.""
Patient: ""Okay.""
Therapist: ""Okay. And just make sure that we have an agreement. Because we're constructing this together. So I need your buy-in. Reading five times a week for a minimum of ten minutes. The next level up was the running. And that was Wednesday night and Saturday morning. Going out two times with your fiancé. And then, once every couple weeks, driving to your friends' or going to their houses and spending the evening with them. All that realistic?""",1030.35,1041.74
030_003,030,3,2,"Well, last time we spoke, I just got a promotion. That's great news. Yeah, great news. I'm really, really excited about the opportunity and the career advancement, but it just hit me that I'm going to be having to give presentations and really kind of be a team leader and kind of be the face of a group of individuals and it's kind of making me a little shaky.","Therapist: ""Hi, Danielle. How are you doing today?""
Patient: ""I'm good. How are you?""
Therapist: ""I'm good. Thanks for asking. What's been going on?""",23.2,54.14
030_007,030,7,2,"It's been bearable, but the thought of having to do it continuously is definitely a little frightening for me.","Therapist: ""A little shaky? Yeah. Are you a big fan of public speaking?""
Patient: ""Not a, I wouldn't say a big fan.""
Therapist: ""No?""",65.11,74.05
030_009,030,9,2,"In this new job, I would actually have to meet with them every week.","Therapist: ""No?""
Patient: ""It's been bearable, but the thought of having to do it continuously is definitely a little frightening for me.""
Therapist: ""That's frightening for you. How often would you have to do, you say continuously, how often would it be in this new job?""",81.98,85.33
030_017,030,17,2,"I've done something like this for school, but definitely not for 30 minutes, not for half an hour.","Therapist: ""All right, so you have 10 people that you're going to have to speak to. Yes. And how long is the talk each week?""
Patient: ""Normally, I would just about like half an hour.""
Therapist: ""Half an hour? Have you ever had to do it in the past or anything like it?""",113.11,119.87
030_019,030,19,5,"That's... I mean, when I did it for school, it was a group of us, so it was less anxiety, but to be doing it by myself for, you know, and all the attention on me, that's, yeah. And 10 people, that's a lot of people, you know, looking up to me and, you know.","Therapist: ""Half an hour? Have you ever had to do it in the past or anything like it?""
Patient: ""I've done something like this for school, but definitely not for 30 minutes, not for half an hour.""
Therapist: ""All right, so the length of time is a major stressor. How about the number of people? How about like 10, is that?""",127.3,146.03
030_025,030,25,1,I can definitely handle that. One-on-one's not too bad.,"Therapist: ""All right, so 10 people for a minute, that wouldn't... That's not too bad. You could handle that.""
Patient: ""I could handle that.""
Therapist: ""Or a half hour with, like, one person.""",169.62,172.09
030_027,030,27,4,"One-on-one's not too bad. But the thought of 10 people staring at me, hanging on my every word for that long, that definitely puts me out there in terms of anxiety.","Therapist: ""Or a half hour with, like, one person.""
Patient: ""I can definitely handle that. One-on-one's not too bad.""
Therapist: ""One-on-one's not too bad?""",173.51,187.07
030_035,030,35,2,I can agree to that.,"Therapist: ""So that's the most stressful it can get.""
Patient: ""Yeah, definitely.""
Therapist: ""That's the most stressful part of your job now, or what your job will be when you take that over. So let's make that, if you agree, we'll make that kind of a five out of five. Okay. So five is the maximum level of anxiety.""",302.87,306.61
030_041,030,41,2,I would definitely say that's like a four and a half or four.,"Therapist: ""That's not too bad? That's definitely not a five out of five.""
Patient: ""No, it's definitely not a five out of five.""
Therapist: ""All right, so let's make that one of the steps. How about speaking to two of the people for around 15 minutes? Make that one of the steps. Okay. And... How about another step would be speaking to four people for 15 minutes? Okay. All right. Which of those two would be scarier? The four people. The four people. For 15 minutes. For 15 minutes. Yeah. All right. And then if we were to say four people for a half hour, what would that rank?""",367.52,371.24
030_047,030,47,1,"No. Not, no. I think that would definitely be my","Therapist: ""All right. Taking those four people and talking to them for a half hour, maybe one one more level up.""
Patient: ""Yeah.""
Therapist: ""So where would all ten people for 15 minutes rank? Would that be more anxiety provoking than four for a half hour? Definitely. Yeah. Because of the duration, yeah. But not as anxiety provoking as ten people for a half hour.""",417.48,421.09
030_053,030,53,1,Yeah. Does that make sense? That makes complete sense to me.,"Therapist: ""And you'd agree that the first step, the least anxiety-provoking, the two people, 15 minutes, that's not a huge deal for you?""
Patient: ""No.""
Therapist: ""You think you could handle that? I could handle it. All right. So what my hope is, is that you move into each step. You conduct that step. You take part in that behavior enough times to where, even though it's a little anxiety provoking in the beginning, you do enough times to where that anxiety comes down. Okay. So you have six weeks to get through really four of the steps because the final step will be all 10 people. So you have six weeks to get through these four steps. Okay. So for this, let's use this first step for this next week, because I'll see you again in a week. And meet with two people, and you probably want to vary it, like two different people each time. If you didn't, they also might wonder what you're doing, if you're meeting the same people over and over. But make it productive, make it part of your job. Make it something that's necessary for your job, like you can see an opportunity where you have to talk. Remember, it's about 15 minutes. If it ends up being 10 or 20, about 15 minutes. And meet with them a few times this week, and I'm hoping that through this week you'll notice that your anxiety decreases. So right after the meeting, if you could just take a quick second and note kind of how stressed you were at the beginning, maybe a scale of 1 to 10, 10 being really anxious, and how stressed you were at the end. And any thoughts you might be having in terms of like what you were thinking while it was going on or what you're thinking afterwards. Like maybe you're going to think, well, I held up pretty well. Okay. Or maybe you're thinking that was still a little stressful. Okay. Or somewhere in between.""",577.15,580.77
031_003,031,3,2,"I still catch myself almost like double touching, like going to touch it and then reeling back. So I'm starting to notice it, but I still have that anxiety. I still don't want to touch it.","Therapist: ""How's Victoria doing today?""
Patient: ""Pretty good.""
Therapist: ""Very good? How has the anxiety been around the germs?""",26.59,42.62
031_005,031,5,4,"Well, I had to go to the store, which is always a nightmare for me because I don't even like touching my credit card because it's been in so many machines and there's so much dirt and junk that gets in there. And then the counters and all the, I keep thinking about the food that's there. And, you know, if I pick it up off the shelf, how many people have picked it up with their nasty hands or kids picked it up with nasty hands and then put it back. And it's like I need to eat, but shopping's a nightmare for me.","Therapist: ""Very good? How has the anxiety been around the germs?""
Patient: ""I still catch myself almost like double touching, like going to touch it and then reeling back. So I'm starting to notice it, but I still have that anxiety. I still don't want to touch it.""
Therapist: ""When you pretty much touch anything that you might think has germs on it. Yeah. What are some things that you've touched in the last, between the last session and this session that have distressed you?""",55.33,89.99
031_013,031,13,2,"I'm really not liking the covers on this chair. Because, I mean, I can't, I mean, at least what I'm sitting in now, my clothes are protecting me from the rest of the chair. But, I mean, I have no sleeves on, so I don't like touching the armrests and the covers.","Therapist: ""I remember I indicated that we might try some experiments right in session. to see how we can move kind of forward in treating your fear, obsession with germs, and really the anxiety it's causing for you. It's like getting in the way of your life.""
Patient: ""It is. It really is.""
Therapist: ""So I was wondering, is there anything in here, in this office as you look around, that you would, Look at it and think, I don't want to touch that because it could have germs on it.""",158.15,176.32
031_015,031,15,2,I'm not liking it. I really feel like I should probably go wash my arms.,"Therapist: ""So I was wondering, is there anything in here, in this office as you look around, that you would, Look at it and think, I don't want to touch that because it could have germs on it.""
Patient: ""I'm really not liking the covers on this chair. Because, I mean, I can't, I mean, at least what I'm sitting in now, my clothes are protecting me from the rest of the chair. But, I mean, I have no sleeves on, so I don't like touching the armrests and the covers.""
Therapist: ""So you've been thinking about, like, your arms touching the back of the chair.""",180.75,187.07
031_017,031,17,4,To go wash my arms until I feel like it's gone. Until all the dirt is gone.,"Therapist: ""So you've been thinking about, like, your arms touching the back of the chair.""
Patient: ""I'm not liking it. I really feel like I should probably go wash my arms.""
Therapist: ""So what would happen if you put your hands right on the arm covers? What would your usual reaction be to that?""",197.66,204.33
031_019,031,19,2,"I mean, something like this probably... I'd probably be in there for a good five, ten minutes just washing.","Therapist: ""So what would happen if you put your hands right on the arm covers? What would your usual reaction be to that?""
Patient: ""To go wash my arms until I feel like it's gone. Until all the dirt is gone.""
Therapist: ""And how long would that take you to be sure that all the...""",208.05,217.33
031_021,031,21,4,I don't keep track anymore. It makes me upset. How many times?,"Therapist: ""And how long would that take you to be sure that all the...""
Patient: ""I mean, something like this probably... I'd probably be in there for a good five, ten minutes just washing.""
Therapist: ""Five, ten minutes. Yeah. And how many times a day would you end up washing your hands?""",222.69,227.36
031_025,031,25,5,"I can just, I feel the chair and I don't like it. And I just, I feel almost like I can feel everybody who's ever touched it and just what have they been doing And what did they touch before they touched this? And they probably didn't wash their hands before they touched this. And it's just really making it uncomfortable.","Therapist: ""It's that many.""
Unknown: ""Mm-hmm.""
Therapist: ""Yeah. That is distressing. And I know that this will be uncomfortable. But I would like you to try to, if you can, if you're comfortable with it, Put your hands on the arms of the chairs. On the chair. Just feel it, see what I'm doing? And it's like, try to stay like that. So tell me what's going through your mind.""",258.95,280.17
031_031,031,31,2,I would say about six or seven.,"Therapist: ""Is it tolerable?""
Patient: ""Yeah.""
Therapist: ""All right. So I want you, remember we talked about scaling before. So like 10 being a tremendous amount of anxiety and 1 being hardly any anxiety. Where are you now? As you sit here with your... hands?""",302.49,304.87
031_037,031,37,4,That someone who's been in this chair was sick or touched something gross that can make you sick. And I'm gonna get sick and I'm gonna die. And I don't wanna die.,"Therapist: ""Yeah, so this is a six or seven. I want you to sit with it for a few seconds. All right? Okay. All right, so process that feeling, right, that you're touching everybody that's ever You've been in the chair, right, so consider that thought. Okay. So what's the ultimate fear? Like, what's gonna happen if you don't go wash your hands now?""
Patient: ""I'm gonna get sick.""
Therapist: ""You're gonna get sick.""",349.38,360.42
031_039,031,39,2,"I feel like it's harder to breathe, I guess. My chest is kind of... Is it tight? Yeah.","Therapist: ""You're gonna get sick.""
Patient: ""That someone who's been in this chair was sick or touched something gross that can make you sick. And I'm gonna get sick and I'm gonna die. And I don't wanna die.""
Therapist: ""Do you feel yourself getting sick?""",369.53,377.2
031_043,031,43,4,But I feel like if I touch my clothes... That's even worse. Yeah. Yeah. Then I'll have to go home and change my clothes.,"Therapist: ""You can still breathe, though?""
Patient: ""I can breathe. Okay.""
Therapist: ""So go ahead and lift your hands up. And just put them where you'd normally put them. Well, now that you've touched the chair, I know that... Is that any better? Now you're touching the seat of the chair.""",394.31,400.33
031_045,031,45,4,"At this point, I feel like they're already contaminated.","Therapist: ""So go ahead and lift your hands up. And just put them where you'd normally put them. Well, now that you've touched the chair, I know that... Is that any better? Now you're touching the seat of the chair.""
Patient: ""But I feel like if I touch my clothes... That's even worse. Yeah. Yeah. Then I'll have to go home and change my clothes.""
Therapist: ""All right. So the thought now, if I had to guess, correct me if I'm wrong, is probably like you really would like to wash your hands. Very much so. Yeah. And you certainly can at any time, but I'd like you to try to hold out for a little bit. So your hands where they are now, that's better than up here.""",425.09,428.94
031_047,031,47,4,"Yeah, I'm just trying to avoid touching anything else.","Therapist: ""All right. So the thought now, if I had to guess, correct me if I'm wrong, is probably like you really would like to wash your hands. Very much so. Yeah. And you certainly can at any time, but I'd like you to try to hold out for a little bit. So your hands where they are now, that's better than up here.""
Patient: ""At this point, I feel like they're already contaminated.""
Therapist: ""So they're at maximum contamination. Yeah. So you can't do any more damage by touching the seat.""",434.62,436.97
031_049,031,49,1,"I mean, now that you mention it, it is a little better. I want to say about four.","Therapist: ""So they're at maximum contamination. Yeah. So you can't do any more damage by touching the seat.""
Patient: ""Yeah, I'm just trying to avoid touching anything else.""
Therapist: ""Right. So now it's not so much about getting your hands away from the arms, but getting them under the faucet. Yeah. So your anxiety was a six or seven before. Where is it now?""",454.53,461.86
031_053,031,53,1,"I mean, I feel better that my arms are all fit. And I'm focusing on breathing.","Therapist: ""About four?""
Patient: ""Three, four.""
Therapist: ""Three, four?""",465.46,471.73
031_057,031,57,2,A one.,"Therapist: ""And I mean... Is it a little easier to breathe now?""
Patient: ""A little, yeah. It is.""
Therapist: ""So if you could wash your hands for just a second, of course you can, but if you did, What would the anxiety move to?""",486.33,488.39
031_059,031,59,2,"I mean, it would take a little bit to get to a one.","Therapist: ""So if you could wash your hands for just a second, of course you can, but if you did, What would the anxiety move to?""
Patient: ""A one.""
Therapist: ""A one.""",490.35,492.89
031_061,031,61,2,"Yeah, actually washing, but then it'll get to a one. Then I'll feel okay.","Therapist: ""A one.""
Patient: ""I mean, it would take a little bit to get to a one.""
Therapist: ""A little bit of hand, like you'd have to wash them?""",495.06,501.75
031_063,031,63,1,"Oh, wow. I didn't consider that.","Therapist: ""A little bit of hand, like you'd have to wash them?""
Patient: ""Yeah, actually washing, but then it'll get to a one. Then I'll feel okay.""
Therapist: ""All right, so you've moved from just in a short time, from a six or seven to a three or four for anxiety. Well, of course, the goal was one. Right, so you could say roughly halfway, roughly halfway down toward your goal without washing your hands at all.""",525.82,529.55
031_067,031,67,4,"I mean, as we keep talking, I feel like it's at two.","Therapist: ""So are you doing okay? You're holding up okay? Mm-hmm. All right. So this is what I want you to do. Before you go wash your hands, I want to use this moment to give you some ideas for the next few weeks. When you touch something that causes you to feel like the germs are on your hands, chairs, whatever it is, I want you to try progressively to wait more and more time between that event, like when you feel that urge, when you actually wash your hands. Okay. I mean, you have to wash your hands at some point. You're going to wash them at some point. That's normal. I'm asking you to try to delay that. Okay. Try to stall and not wash them immediately. Okay. Eventually, I want to get to the point where you can wash them when you choose to. Because right now, the germs are kind of dictating""
Patient: ""when I wash them.""
Therapist: ""Right, I mean, the way you're thinking about the germs is really laying down the rules. And I want to give you some more control over it. So where's the anxiety right now?""",615.67,621.62
031_069,031,69,1,"I'd still like to go wash my hands. I would feel better if I did, but I don't feel that, you know, overwhelming anxiety anymore. And no trouble breathing or... Actually, I haven't even thought about that in a while.","Therapist: ""Right, I mean, the way you're thinking about the germs is really laying down the rules. And I want to give you some more control over it. So where's the anxiety right now?""
Patient: ""I mean, as we keep talking, I feel like it's at two.""
Therapist: ""At two?""",623.22,636.81
032_003,032,3,1,"Well, I think it's been going pretty well. I've been able to, you know, wait pretty good. I mean, it started out slow, like you suggested, with three minutes, then I would wash my hands or five minutes I'd wash my hands and I got up to about 15 minutes.","Therapist: ""Hi, Victoria.""
Patient: ""How are you doing today? I'm doing okay.""
Therapist: ""You're doing okay? It's been a while now. You've been practicing with the waiting after you wash your hands. How's that been going for you?""",29.87,47.43
032_005,032,5,1,And there were some times that I was really proud of myself that I actually forgot.,"Therapist: ""You're doing okay? It's been a while now. You've been practicing with the waiting after you wash your hands. How's that been going for you?""
Patient: ""Well, I think it's been going pretty well. I've been able to, you know, wait pretty good. I mean, it started out slow, like you suggested, with three minutes, then I would wash my hands or five minutes I'd wash my hands and I got up to about 15 minutes.""
Therapist: ""That's great.""",48.49,52.52
032_013,032,13,4,"Yeah, I was really proud of myself, but I got really concerned because I got sick. I got sick recently, and I'm afraid it's from one of those times that I didn't wash my hands.","Therapist: ""Which is when you normally wash your hands. So really you touched something that had germs and you had some anxieties you had to get to that waiting period. But then the anxiety subsided to a point where...""
Patient: ""I forgot about it.""
Therapist: ""It just wasn't a priority. You just completely forgot and went on with your day.""",82.84,95.63
032_015,032,15,4,"Well, I know... my throat started to get hurt real bad and I was just really congested and all I could think about was it's because I didn't wash my hands when I went to the store or when I went to my car when I touched you know a jacket that's you know been everywhere how many times do you normally get it sounds like a cold I mean, it was kind of a light cold.","Therapist: ""It just wasn't a priority. You just completely forgot and went on with your day.""
Patient: ""Yeah, I was really proud of myself, but I got really concerned because I got sick. I got sick recently, and I'm afraid it's from one of those times that I didn't wash my hands.""
Therapist: ""Well, tell me about the sickness.""",98.25,129.24
032_019,032,19,1,"I mean, I get sick, I mean, quite often because of my job. I'm around a lot of people and hand sanitizer can only work so much. I do get sick.","Therapist: ""Light cold?""
Patient: ""I mean, it went away in a few days.""
Therapist: ""A couple days? So how long or how many times a year would you get something like that normally?""",138.49,151.69
032_021,032,21,2,"I suppose not. I mean, the rational part of me knows that I get sick. That just because I'm trying something new with the you know and then the waiting and then not washing I'm just afraid that there was no you're afraid they were linked in one that won't cause the other than waiting to wash your hands Gosh you're sick.","Therapist: ""A couple days? So how long or how many times a year would you get something like that normally?""
Patient: ""I mean, I get sick, I mean, quite often because of my job. I'm around a lot of people and hand sanitizer can only work so much. I do get sick.""
Therapist: ""So it's been six weeks since you started waiting, right? I think it was around session three where we talked about putting a gap between when you touch something and when you wash your hands, like a time gap. And you got a cold once. Would that be out of the ordinary to get a cold one time in six weeks this time of year?""",178.72,205.49
032_023,032,23,1,"It wasn't severe. I mean, I took some, you know, over-the-counter medicine and slept it off.","Therapist: ""So it's been six weeks since you started waiting, right? I think it was around session three where we talked about putting a gap between when you touch something and when you wash your hands, like a time gap. And you got a cold once. Would that be out of the ordinary to get a cold one time in six weeks this time of year?""
Patient: ""I suppose not. I mean, the rational part of me knows that I get sick. That just because I'm trying something new with the you know and then the waiting and then not washing I'm just afraid that there was no you're afraid they were linked in one that won't cause the other than waiting to wash your hands Gosh you're sick.""
Therapist: ""All right and That could have happened, I don't know but let's talk about I the cold. You said it was a couple days?""",218.22,225.19
032_025,032,25,1,"No, I've definitely been sicker in my life. And, I mean, it did seem like one of those ones that I get every now and then.","Therapist: ""All right and That could have happened, I don't know but let's talk about I the cold. You said it was a couple days?""
Patient: ""It wasn't severe. I mean, I took some, you know, over-the-counter medicine and slept it off.""
Therapist: ""So it wasn't a catastrophe?""",229.27,237.69
032_027,032,27,2,"Yeah, I was, which I found kind of odd, because I was panicked. At the beginning, when I started to feel those first, you know, the itchy throat, the headaches.","Therapist: ""So it wasn't a catastrophe?""
Patient: ""No, I've definitely been sicker in my life. And, I mean, it did seem like one of those ones that I get every now and then.""
Therapist: ""So when we spoke, I remember before you had said that the kind of the worst case scenario, the reason that you're thinking so much about the germs on your hands is that it could make you sick. But you did get sick, and you were able to tolerate it?""",263.61,273.95
032_029,032,29,1,"And then I got concerned, you know, that it was because of that. Then it just kind of subsided, I guess. I felt a little better. You know, as the days went on, I felt better about it happening.","Therapist: ""So when we spoke, I remember before you had said that the kind of the worst case scenario, the reason that you're thinking so much about the germs on your hands is that it could make you sick. But you did get sick, and you were able to tolerate it?""
Patient: ""Yeah, I was, which I found kind of odd, because I was panicked. At the beginning, when I started to feel those first, you know, the itchy throat, the headaches.""
Therapist: ""Sure, it's miserable, right? Nobody wants to get sick.""",277.08,294.02
032_035,032,35,2,"I mean, in my head, not washing my hands and the sick that I would get is a lot worse. It's, like, hospital-worthy, and this was, you know, like I said, over-the-counter, you know, just relax a little bit.","Therapist: ""Right. Because you do get sick several times.""
Patient: ""Several times a year.""
Therapist: ""Yeah, a year or so. So there's a lot we don't know, but we do know that you survived it, and it wasn't as bad looking back at it.""",333.47,348.45
032_037,032,37,1,"It definitely wasn't pleasant, but it wasn't as bad as it could have gone in my mind.","Therapist: ""Yeah, a year or so. So there's a lot we don't know, but we do know that you survived it, and it wasn't as bad looking back at it.""
Patient: ""I mean, in my head, not washing my hands and the sick that I would get is a lot worse. It's, like, hospital-worthy, and this was, you know, like I said, over-the-counter, you know, just relax a little bit.""
Therapist: ""So not pleasant, but survivable.""",353.13,359.96
032_039,032,39,3,"I mean, I definitely don't like the excess of hand washing. I don't. I mean, it ruins my skin, and it's expensive, and it makes me feel bad about myself. And, I mean, I guess the trade-off is if I get a little sick, then that would be okay.","Therapist: ""So not pleasant, but survivable.""
Patient: ""It definitely wasn't pleasant, but it wasn't as bad as it could have gone in my mind.""
Therapist: ""So presume for a moment that it was a consequence of not immediately rushing over and washing your hands. What would you rather have? The occasional cold like that or the excessive hand washing and the anxiety?""",380.57,399.64
032_043,032,43,2,"And I can see now your arms are... Oh, I didn't even notice I was doing that. Oh. I don't... You know, even noticing it, I don't feel like I need to go, you know, wash my elbows or anything.","Therapist: ""And again, that's presuming that it did cause you to get sick, which it may not have.""
Patient: ""I suppose that's true.""
Therapist: ""So I wanted to point out, too, that I remember when we first started the exposure response prevention exercise, we did right here in session by touching the arms of the chair.""",423.69,439.41
032_045,032,45,1,"No, I don't. I mean, I know that it's dirty. I know that people sit here and people can be dirty, but I don't feel that need to go wash my hands right now.","Therapist: ""So I wanted to point out, too, that I remember when we first started the exposure response prevention exercise, we did right here in session by touching the arms of the chair.""
Patient: ""And I can see now your arms are... Oh, I didn't even notice I was doing that. Oh. I don't... You know, even noticing it, I don't feel like I need to go, you know, wash my elbows or anything.""
Therapist: ""You don't feel that?""",440.69,457.41
032_047,032,47,1,"I mean, on that scale, I think it'd be about a two.","Therapist: ""You don't feel that?""
Patient: ""No, I don't. I mean, I know that it's dirty. I know that people sit here and people can be dirty, but I don't feel that need to go wash my hands right now.""
Therapist: ""So your anxiety increased a little when I told you, when I pointed out that you were touching it, but not as much as it did before.""",467.88,472.34
032_049,032,49,1,"Well, when you pointed it out, I didn't notice before.","Therapist: ""So your anxiety increased a little when I told you, when I pointed out that you were touching it, but not as much as it did before.""
Patient: ""I mean, on that scale, I think it'd be about a two.""
Therapist: ""Well, with one being the lowest anxiety and ten being the highest, you'd be about a two.""",478.69,481.25
032_053,032,53,1,"I mean, not so much anymore. I mean, it's kind of, you mentioned it. I got anxious.","Therapist: ""So you were a one in anxiety before that. Mm-hmm. So now you're aware of it a little bit, right? So your elbows, your elbows have touched the chair.""
Patient: ""Yeah.""
Therapist: ""And you're aware of it a little bit, and you're a little anxious.""",499.51,506.5
032_055,032,55,1,"And then it's just kind of like, oh, well, you're already doing it. And nothing bad's happening right now.","Therapist: ""And you're aware of it a little bit, and you're a little anxious.""
Patient: ""I mean, not so much anymore. I mean, it's kind of, you mentioned it. I got anxious.""
Therapist: ""For a moment.""",508.08,517.72
032_059,032,59,4,Because it gets really bad. It starts consuming me.,"Therapist: ""Well, good. You've made a lot of progress. Thank you. A lot of progress. So you're still going to have, as we move forward, you're still going to have some Anxiety like when I mentioned that your arms are touching the chair. You're still gonna have some anxiety from time to time Right anxieties Part of life. Yeah, it's it's gonna happen from time to time so one of the things I hope that You've gained from this is that just like you tolerate being sick for those few days Right is the tolerate that anxiety To be able to be okay with having some anxiety in your life.""
Patient: ""Okay.""
Therapist: ""In a sense, the fear of being anxious kind of causes a vicious cycle. You have a fear of being anxious. You'll do, not anything, but you'll do many things to get rid of that anxiety.""",586.22,590.0
032_063,032,63,1,"To kind of live through it. Yeah, I would really say that.","Therapist: ""Yeah, it's uncomfortable. I remember when you touched the chair before, right, like many weeks ago, that you had the urge to go wash your hands right away. You were anxious.""
Patient: ""Yeah, I remember that.""
Therapist: ""So you become less anxious by waiting and kind of getting used to it. And with that remaining anxiety, what I'm getting at is that at some point you have to learn tolerate that. And it sounds like that's the kind of direction you're moving. That you're able to tolerate, like the anxiety is still unpleasant for you, but you're able to survive.""",631.84,636.53
032_065,032,65,1,"I mean, the little bit of unpleasantness versus, you know, the depression and the anxiety that comes with washing my hands. I'd really rather take the little unpleasantness, I guess, in the grand scheme of things, yeah.","Therapist: ""So you become less anxious by waiting and kind of getting used to it. And with that remaining anxiety, what I'm getting at is that at some point you have to learn tolerate that. And it sounds like that's the kind of direction you're moving. That you're able to tolerate, like the anxiety is still unpleasant for you, but you're able to survive.""
Patient: ""To kind of live through it. Yeah, I would really say that.""
Therapist: ""So tolerating that degree of anxiety, is that better than the frequent hand washing?""",647.24,661.24
032_067,032,67,2,"On average, because I write them down, on average I wait a good seven minutes.","Therapist: ""So tolerating that degree of anxiety, is that better than the frequent hand washing?""
Patient: ""I mean, the little bit of unpleasantness versus, you know, the depression and the anxiety that comes with washing my hands. I'd really rather take the little unpleasantness, I guess, in the grand scheme of things, yeah.""
Therapist: ""So where are you now in terms of how many minutes do you wait after you touch something?""",671.13,679.14
032_069,032,69,1,"You know, wash them after eating or before eating, touching anything, you know, like a toilet or stuff like that. So definitely a fraction of what I do.","Therapist: ""So where are you now in terms of how many minutes do you wait after you touch something?""
Patient: ""On average, because I write them down, on average I wait a good seven minutes.""
Therapist: ""So you've been averaging around seven minutes. So I want to continue ramping that up. So if you had no awareness of germs, how many times would you normally wash your hands in a day?""",696.75,713.91
032_077,032,77,2,"Yeah, you know, choosing to wash my hands instead of needing to wash my hands.","Therapist: ""For you. And you were way beyond that before.""
Patient: ""Yeah.""
Therapist: ""Right. So we'll keep working those minutes up, right, using that same schedule, and try to get to the point where you're only washing your hands when you really want to, when you normally would. rather than because you're being pushed to by the compulsion. Does that make sense?""",744.97,750.93
033_003,033,3,2,Okay. Yeah?,"Therapist: ""Hi, Sarah. How are you doing today?""
Patient: ""Good.""
Therapist: ""Doing well?""",18.42,20.56
033_011,033,11,5,"Well, Mary's been crying a lot, and I'm really tired. So I've needed extra help, you know, with her because I'm so tired and I just can't get out of bed.","Therapist: ""So you're still having sadness?""
Patient: ""Yeah.""
Therapist: ""Yeah. And frustrated? Yeah. Yeah. So tell me what's going on this last week.""",41.24,50.05
033_013,033,13,4,"I don't know, maybe 8, 10, maybe more.","Therapist: ""Yeah. And frustrated? Yeah. Yeah. So tell me what's going on this last week.""
Patient: ""Well, Mary's been crying a lot, and I'm really tired. So I've needed extra help, you know, with her because I'm so tired and I just can't get out of bed.""
Therapist: ""How much have you been sleeping each night, like, on average?""",57.76,60.83
033_015,033,15,2,"Um... I don't know, maybe six, eight at the most.","Therapist: ""How much have you been sleeping each night, like, on average?""
Patient: ""I don't know, maybe 8, 10, maybe more.""
Therapist: ""Maybe more? Yeah. And how long did you sleep each night before you had Mary?""",71.54,75.7
033_019,033,19,2,"I'm kind of feeling, you know, like I'm not doing good with Mary, that maybe I should think about getting a job again.","Therapist: ""So your sleep habits have changed a bit.""
Patient: ""Yeah.""
Therapist: ""And you talked last time about feeling sad. What else has changed?""",85.83,99.79
033_021,033,21,4,"I just remember with George, you know, he would cry in the middle of the night and I would hop right up. And with Mary, when she cries, I just want to roll over.","Therapist: ""And you talked last time about feeling sad. What else has changed?""
Patient: ""I'm kind of feeling, you know, like I'm not doing good with Mary, that maybe I should think about getting a job again.""
Therapist: ""And when you say not doing good with Mary, what specifically is going on that's contributing to that thought?""",112.27,120.84
033_027,033,27,2,"I can't think of anything, but I'm sure there is.","Therapist: ""You still do care for her, though.""
Patient: ""Yeah.""
Therapist: ""Yeah. Mm-hmm. Anything else that's changed?""",143.24,145.64
033_029,033,29,4,"I'm not really sure. Maybe just because she's crying all the time and I don't feel like I did with George. Everyone said I did such a good job with him and I was a fantastic mother and I was doing such a great job. People are saying it, but I just don't feel like I'm doing as good a job as I did with him.","Therapist: ""Yeah. Mm-hmm. Anything else that's changed?""
Patient: ""I can't think of anything, but I'm sure there is.""
Therapist: ""Well, tell me more about the sadness. Where do you think that's coming from?""",158.42,180.31
033_035,033,35,1,"Yeah, because she's, you know, little. She's only six weeks now. So, yeah, she would go to daycare.","Therapist: ""So their piece really hasn't changed. Like, they're still giving you the same feedback. Mm-hmm. But your feelings definitely have changed.""
Patient: ""Yeah.""
Therapist: ""To the point where you feel like you should just get a full-time job and, I guess, marry, go to daycare?""",216.71,221.65
033_037,033,37,2,"Kind of mixed feelings. Like I was home with George until he went to school, so I feel like Mary wouldn't be getting the same thing that George got, but I feel like she's not getting the same thing right now.","Therapist: ""To the point where you feel like you should just get a full-time job and, I guess, marry, go to daycare?""
Patient: ""Yeah, because she's, you know, little. She's only six weeks now. So, yeah, she would go to daycare.""
Therapist: ""So what comes to mind when you consider doing that, like working full time?""",234.21,246.2
033_041,033,41,1,"I would sing to him a lot, and we would read books. You know, I started reading to him when he was still in my belly, and then when he came out, everyone was like, oh, it's too soon. But we would read all the time. I would take him to the playground quite often.","Therapist: ""Like you're just not doing the same quality job.""
Patient: ""Right.""
Therapist: ""Yeah. What kind of things did you do with George that you look forward to, like when he was that age?""",264.02,279.29
033_047,033,47,2,"I try to, but maybe it's because she's a little fussier. You know, I try singing to her, and with George it would be like one or two songs, maybe even just one song, and he'd calm down. And Mary's just not the same. It takes longer, or she just doesn't respond to singing or reading books like he did.","Therapist: ""And that was something you really look forward to?""
Patient: ""Yeah.""
Therapist: ""Have you done those same things with Mary?""",291.9,312.09
033_055,033,55,2,"I don't know. I mean, you know, some of my girlfriends have kids the same age or babies the same age and they're going back to work now or they have been working for a while and I kind of feel like now that they're working and have two kids, they kind of look down on me.","Therapist: ""So part of this could be just adapting to her personality?""
Patient: ""Maybe.""
Therapist: ""Maybe. What else could be a part of it?""",361.7,377.63
033_059,033,59,2,"It's kind of just a feeling and, um, I forget exactly what she said, but one of my friends was like, oh, you have so much time to do all this and I'm always working. And it just, the way she worded it kind of made it feel like, you know, I have so much to do. What are you doing?","Therapist: ""So they look upon you negatively because you don't work?""
Patient: ""Yeah.""
Therapist: ""Now you say you get that feeling, is there, do you have evidence that you, when we talked about cognitive behavioral therapy and evaluating evidence, do you have evidence that that's the way they feel?""",400.46,419.19
033_065,033,65,4,six six so after you had george there was really no period of sadness from what you reported no it was just not sadness it was just having to get used to having a baby around but adjustment yeah he was my first and i was so ecstatic to have him and my husband and i were so happy you know he was our first baby we were really happy with it with him and you don't have that same,"Therapist: ""You know, your, your place. Yeah. Well, I can see how that would hurt. And there's always going to be people people that say things that we prefer they not say, or feel a way that we perceive negatively as a negative effect. But this sadness, I mean, as we've been talking about it in weeks prior, is really markedly worse than what you've experienced ever before.""
Patient: ""Yeah.""
Therapist: ""So, you know, after you had, how old is George now?""",462.84,491.5
033_067,033,67,5,"It's not that I'm not happy to have Mary. It's just, I don't know, I feel like things are so different. You know, I have George to take care of. He's running around. I can't give him my full attention anymore. Mary's constantly crying and I can't seem to soothe her and I just get frustrated with her.","Therapist: ""So, you know, after you had, how old is George now?""
Patient: ""six six so after you had george there was really no period of sadness from what you reported no it was just not sadness it was just having to get used to having a baby around but adjustment yeah he was my first and i was so ecstatic to have him and my husband and i were so happy you know he was our first baby we were really happy with it with him and you don't have that same""
Therapist: ""that same feeling now?""",495.97,516.15
033_073,033,73,4,"Right. You know, with George, he would start to fuss and cry, and I could get him calmed down fairly quickly. But with Mary, you know, she starts crying and fussing, and I feel like, it may only take like 15 or 20 minutes but to me it just feels so much longer and I give up at a certain point and I just hand her off to whoever's closest and they seem to get her soothed right away.","Therapist: ""Because he has to fit into a family with a new member. So there's a lot going on in your mind and a lot of different feelings. But still the sadness is when you first came in, this was really what was on your mind, right? Sleeping more than you wanted, not really experiencing enjoyment with Mary the way you'd hoped.""
Patient: ""Right.""
Therapist: ""And then, I think, too, kind of a negativistic view of your situation that we talked about. You're seeing things from a negative point of view when before you reported you had not.""",568.2,595.07
033_077,033,77,2,Yeah. I mean when I can't soothe her and I just hand her off I feel like I'm not a good mom to her like I was with George.,"Therapist: ""Which may be all the more frustrating because you couldn't.""
Patient: ""Exactly.""
Therapist: ""So have you had any feelings of like guilt or anything like that?""",607.95,615.99
033_085,033,85,1,"Um, I would definitely say reading and singing to her and just, you know, being able to hold her when she was calm.","Therapist: ""But the alternative is an avoidance, oftentimes, is an avoidance of those activities which can make things even worse.""
Patient: ""Makes sense.""
Therapist: ""That makes sense? Mm-hmm. So, in this particular case, what's going on with, you know, your family having to adjust to a new member, what activities were you really looking forward to like when you're pregnant? Like what things you're looking forward to doing with Mary that, that we could kind of schedule, like that we could kind of plan for you to do?""",714.59,721.74
033_087,033,87,2,"I guess just thinking back to what I used to do with George was taking him to the park and I was really looking forward to that with Mary, but it just didn't happen.","Therapist: ""That makes sense? Mm-hmm. So, in this particular case, what's going on with, you know, your family having to adjust to a new member, what activities were you really looking forward to like when you're pregnant? Like what things you're looking forward to doing with Mary that, that we could kind of schedule, like that we could kind of plan for you to do?""
Patient: ""Um, I would definitely say reading and singing to her and just, you know, being able to hold her when she was calm.""
Therapist: ""Okay. Okay. So reading to her, singing to her. Anything else? Anything else that you were Like back when you were pregnant, you were thinking, oh, that would be really fun if I could do that with my child.""",737.51,747.19
033_089,033,89,4,"We went once so far with some of my girlfriends and then it was okay. And then she got fussy towards the end and the next time, you know, I said I would go and I just didn't.","Therapist: ""Okay. Okay. So reading to her, singing to her. Anything else? Anything else that you were Like back when you were pregnant, you were thinking, oh, that would be really fun if I could do that with my child.""
Patient: ""I guess just thinking back to what I used to do with George was taking him to the park and I was really looking forward to that with Mary, but it just didn't happen.""
Therapist: ""It's not been happening, huh? Have you tried before to go to the park? Like have you started like packing or getting your car keys and getting things ready?""",760.93,774.0
033_091,033,91,2,"I just kind of, I guess I got sad thinking about what happened the last time. So it just frustrated me and I didn't want to end up, you know, unhappy.","Therapist: ""It's not been happening, huh? Have you tried before to go to the park? Like have you started like packing or getting your car keys and getting things ready?""
Patient: ""We went once so far with some of my girlfriends and then it was okay. And then she got fussy towards the end and the next time, you know, I said I would go and I just didn't.""
Therapist: ""So what happened at that moment when you said you were going to go and it was getting close to the time you wanted to go? What happened then that led to you not going?""",786.4,797.51
033_095,033,95,1,"Not many times a day, but it would be like consistently every day for like 20 minutes a day.","Therapist: ""So feelings of sadness and thoughts that you would be unhappy. Mm-hmm. Okay. So that's one of the obstacles that we'll have to look at with that particular behavior. So I like to plan these things out. Let's go with those three things that you have. Okay. So you have the readings. Right, and singing and I presume both of those you just do in your home.""
Patient: ""Right.""
Therapist: ""And then the going to the playground? To the park. To the park, okay. Which this time of year, I imagine you could go almost every day. Yeah. Was that something you would have done? Yes. With George? Yeah, I did do. All right, so maybe we can schedule this. The reading How many times a day did you do that with George? Say average.""",854.31,859.98
033_099,033,99,2,"Probably, well, it's summertime now, but I would have said when George is in school, because he wouldn't be there bugging me. So right now, maybe like right after dinner time for her.","Therapist: ""20 minutes a day? Mm-hmm. All right. So within the scope of everything you're doing, caring for Mary, 20 minutes isn't a lot of time.""
Patient: ""No.""
Therapist: ""So do you want to set that as a goal? So maybe like during the? like Monday through Friday, because I know on the weekends you do other things. 20 minutes a day, Monday through Friday, would be like reading time with her. Okay. What's a time of day that you think would be realistic to do that, based on everybody's schedule?""",897.15,912.95
033_107,033,107,4,"With George, you know, it was just like twinkle, twinkle, little star. ABCs and just you know his favorite song was the ants go marching one by one okay so I get so frustrated I haven't found her favorite song yet or maybe I did and maybe I missed it but I guess just starting off with twinkle twinkle and ABC again would be good all right is a particular time in the day when seeing is convenient With Mary, I'd say maybe right before bedtime.","Therapist: ""You believe it's something that'd be good for Mary?""
Patient: ""I do.""
Therapist: ""So maybe that's the thought you carry into that when other thoughts come up. We'll talk more about the thoughts later, but when other thoughts come up that attempt to derail that, the thought could be, well, this is good for her. Even if it's a little frustrating for me or I don't have the energy or the motivation, it's good for her. Tell me about the singing.""",964.94,1001.06
033_109,033,109,1,"I try and get her in by like 7.30, 8 at the latest.","Therapist: ""So maybe that's the thought you carry into that when other thoughts come up. We'll talk more about the thoughts later, but when other thoughts come up that attempt to derail that, the thought could be, well, this is good for her. Even if it's a little frustrating for me or I don't have the energy or the motivation, it's good for her. Tell me about the singing.""
Patient: ""With George, you know, it was just like twinkle, twinkle, little star. ABCs and just you know his favorite song was the ants go marching one by one okay so I get so frustrated I haven't found her favorite song yet or maybe I did and maybe I missed it but I guess just starting off with twinkle twinkle and ABC again would be good all right is a particular time in the day when seeing is convenient With Mary, I'd say maybe right before bedtime.""
Therapist: ""All right, so about what time is that?""",1005.03,1008.19
033_119,033,119,3,"I mean, eventually I'd like to get to every day again.","Therapist: ""It's good for her. And that's what you want, right?""
Patient: ""Mm-hmm.""
Therapist: ""All right. So we have the reading at roughly 6.30. Mm-hmm. And then the singing. And out of a seven-day week, how many times would you like to sing to her?""",1046.35,1049.32
033_127,033,127,1,I'd say maybe start with like one or two times right now.,"Therapist: ""All right. And then, so that'll be the second step. So the first step's the reading, second step's the singing. And how about going to the playground in the park?""
Patient: ""You mean like how many times?""
Therapist: ""Mm-hmm, how many times in a week?""",1076.81,1084.98
033_129,033,129,5,"With George, I used to go almost every single day. And I just, it's so draining to even think about going with Mary right now because I'm so tired.","Therapist: ""Mm-hmm, how many times in a week?""
Patient: ""I'd say maybe start with like one or two times right now.""
Therapist: ""Let's go one time. Okay. So when I said that, you kind of sighed a little. So tell me what you were thinking right then.""",1094.72,1107.44
033_131,033,131,2,"Yeah, my mom and my mother-in-law live close and I know they have like different days they have off during the week, so one of them, I could choose the day when one of them are off.","Therapist: ""Let's go one time. Okay. So when I said that, you kind of sighed a little. So tell me what you were thinking right then.""
Patient: ""With George, I used to go almost every single day. And I just, it's so draining to even think about going with Mary right now because I'm so tired.""
Therapist: ""So with this one, you're going to have a lot of thoughts and a lot of feelings that might impede. completing that goal. Is there any, are there any other resources we can bring to bear to help you get out of the house once a week, like family supports or anything else?""",1129.97,1141.37
033_133,033,133,1,"To help me, yeah.","Therapist: ""So with this one, you're going to have a lot of thoughts and a lot of feelings that might impede. completing that goal. Is there any, are there any other resources we can bring to bear to help you get out of the house once a week, like family supports or anything else?""
Patient: ""Yeah, my mom and my mother-in-law live close and I know they have like different days they have off during the week, so one of them, I could choose the day when one of them are off.""
Therapist: ""And then maybe ask them to""",1144.63,1147.04
033_137,033,137,2,"Yeah, definitely.","Therapist: ""So does that type of external motivation, like when another person comes over and helps you get ready and maybe, I don't know, goes to the park with you or however that works, does that help you?""
Patient: ""I would say so, yeah.""
Therapist: ""It kind of keeps you moving?""",1161.56,1163.8
033_139,033,139,4,I completely lost it.,"Therapist: ""It kind of keeps you moving?""
Patient: ""Yeah, definitely.""
Therapist: ""You're saying you don't feel?""",1164.66,1169.97
033_141,033,141,4,"Yeah, I feel more like I have to show I'm as good a mom with Mary as I was with George. So it makes me push a little bit harder.","Therapist: ""You're saying you don't feel?""
Patient: ""I completely lost it.""
Therapist: ""It's okay. But the feelings are different? Yeah. When somebody's there to push you a little bit.""",1177.34,1185.53
034_000,034,0,2,I'm doing well. How are you?,(Beginning of session — no prior context),14.97,17.54
034_002,034,2,2,"Um, okay. I've been having some trouble with some friends and stuff. And I just, I think just, people just don't get me. I just don't think people get me.","Patient: ""I'm doing well. How are you?""
Therapist: ""I'm doing well. Thanks for asking. How have things been going?""",22.77,33.46
034_004,034,4,4,"No, they just don't. And right now, I just, you know, I just don't want to be friends with anybody right now. Because but they just don't understand me and I don't know. I think I'm just not going to have friends for a while.","Therapist: ""I'm doing well. Thanks for asking. How have things been going?""
Patient: ""Um, okay. I've been having some trouble with some friends and stuff. And I just, I think just, people just don't get me. I just don't think people get me.""
Therapist: ""They don't understand you? Your friends don't understand you?""",36.23,48.96
034_006,034,6,4,"Well, you know, I just said some things and now it's just gotten out of hand and I just think I need to break from this friendship group for a little bit.","Therapist: ""They don't understand you? Your friends don't understand you?""
Patient: ""No, they just don't. And right now, I just, you know, I just don't want to be friends with anybody right now. Because but they just don't understand me and I don't know. I think I'm just not going to have friends for a while.""
Therapist: ""That seems like a fairly large shift from kind of your position before on having friends. You seem to really like spending time with them. Did something happen that kind of led to this?""",61.19,72.95
034_008,034,8,2,"Yeah, I mean, we were just talking about some things, and, you know, I was just telling them that, you know, I play tennis and I enjoy tennis, and I was just, you know, maybe went on a little bit about how I play tennis.","Therapist: ""That seems like a fairly large shift from kind of your position before on having friends. You seem to really like spending time with them. Did something happen that kind of led to this?""
Patient: ""Well, you know, I just said some things and now it's just gotten out of hand and I just think I need to break from this friendship group for a little bit.""
Therapist: ""You seem upset about this.""",80.37,102.01
034_010,034,10,4,"Well, it's a little embarrassing. I just, I was exaggerating about how I play tennis. And they were telling me how they wanted to go to the U.S. Open and they want to go every year because they love it. And I've never been, really. But I wanted to be part of the conversation a little bit. So I told them that I had studied under a famous tennis player and that they were really impressed with that. And so I just kept talking about that and all the stuff that I learned and told them that I was really good at tennis.","Therapist: ""You seem upset about this.""
Patient: ""Yeah, I mean, we were just talking about some things, and, you know, I was just telling them that, you know, I play tennis and I enjoy tennis, and I was just, you know, maybe went on a little bit about how I play tennis.""
Therapist: ""Tell me about that.""",105.76,146.67
034_012,034,12,4,"I've maybe played a couple of times. And I've never met that person, let alone studied under them. And I really don't know how I got to the point where I was elaborating the story and so they want they want to have some lessons they want to learn what I learned under this person and you know they started talking about getting together and at that moment I kind of got caught up and I said sure and yeah we'll schedule it like Saturday mornings we'll get together and we'll just kind of hit together and play some sets and I I don't know I don't know what to do. It's just really embarrassing now because they're going to know that I really don't know how to play tennis. I could maybe have faked it a little bit, but now they think I've had professional training.","Therapist: ""Tell me about that.""
Patient: ""Well, it's a little embarrassing. I just, I was exaggerating about how I play tennis. And they were telling me how they wanted to go to the U.S. Open and they want to go every year because they love it. And I've never been, really. But I wanted to be part of the conversation a little bit. So I told them that I had studied under a famous tennis player and that they were really impressed with that. And so I just kept talking about that and all the stuff that I learned and told them that I was really good at tennis.""
Therapist: ""And in reality?""",153.46,209.26
034_014,034,14,2,"Right, and they're just going to know. And then they might question some other things I've said","Therapist: ""And in reality?""
Patient: ""I've maybe played a couple of times. And I've never met that person, let alone studied under them. And I really don't know how I got to the point where I was elaborating the story and so they want they want to have some lessons they want to learn what I learned under this person and you know they started talking about getting together and at that moment I kind of got caught up and I said sure and yeah we'll schedule it like Saturday mornings we'll get together and we'll just kind of hit together and play some sets and I I don't know I don't know what to do. It's just really embarrassing now because they're going to know that I really don't know how to play tennis. I could maybe have faked it a little bit, but now they think I've had professional training.""
Therapist: ""So it's going to be very obvious to them that you weren't being completely honest if you have to play tennis with them.""",218.73,223.68
034_016,034,16,2,"Yeah, so.","Therapist: ""So it's going to be very obvious to them that you weren't being completely honest if you have to play tennis with them.""
Patient: ""Right, and they're just going to know. And then they might question some other things I've said""
Therapist: ""Things that are not tennis related?""",227.79,232.54
034_018,034,18,4,This is really hard to admit. It's just stupid. It's stupid. It's just something I do sometimes. I get kind of caught up or I'm feeling left out of a situation and they're all talking about a topic and I want to fit in. I might say a couple of things that make it sound like I know what I'm talking about or that I can relate to the topic when I can't.,"Therapist: ""Things that are not tennis related?""
Patient: ""Yeah, so.""
Therapist: ""Do you feel that in your relationship with these friends that you have not been honest frequently, a few times? Like how would you categorize?""",252.36,279.52
034_020,034,20,2,"Yeah. Yeah. You know, it's hard. I feel stupid just standing there, like, having no idea. Like, when they talk about traveling and seeing different cities and stuff, I haven't really been outside of my small town. You know, I've gone to Florida, went to Disney World, went to Epcot. So, you know, when they're talking about going to Paris and, you know, seeing the Eiffel Tower and seeing Notre Dame or they're talking about going to Rome and, you know, I just, I can't, I can't really, I don't really have anything to say. I don't really have that kind of a life and it's not very exciting. So sometimes I might say stuff about that and it's a lot of little things, you know, that I just, I find myself saying things that aren't true and trying to just go along with what they're talking about when I don't even know what they're saying. You know, when they talk about fashion or they talk about just different things and I don't know what to do in that situation and I'm just finding myself just making things up and saying things that I think that they want to hear. I don't even know if they believe it. I kind of got the feeling this time that they were kind of calling me out because they were getting an idea of what I had been doing and it was really embarrassing. I feel like I just want to run away from the situation and I don't want to talk to anybody and I just want to break off friendships.","Therapist: ""Do you feel that in your relationship with these friends that you have not been honest frequently, a few times? Like how would you categorize?""
Patient: ""This is really hard to admit. It's just stupid. It's stupid. It's just something I do sometimes. I get kind of caught up or I'm feeling left out of a situation and they're all talking about a topic and I want to fit in. I might say a couple of things that make it sound like I know what I'm talking about or that I can relate to the topic when I can't.""
Therapist: ""So in social situations when you're feeling isolated from the conversation, or maybe detached from the people, you create a story that helps reintegrate you back into that conversation.""",299.26,391.96
034_022,034,22,4,I don't want them to know that I have a really boring life and that I'm not as smart as they are and I'm not as successful. I don't want them to know that. I'm kind of like a loser compared to all of their exciting things that they do and say. I just don't match up.,"Therapist: ""So in social situations when you're feeling isolated from the conversation, or maybe detached from the people, you create a story that helps reintegrate you back into that conversation.""
Patient: ""Yeah. Yeah. You know, it's hard. I feel stupid just standing there, like, having no idea. Like, when they talk about traveling and seeing different cities and stuff, I haven't really been outside of my small town. You know, I've gone to Florida, went to Disney World, went to Epcot. So, you know, when they're talking about going to Paris and, you know, seeing the Eiffel Tower and seeing Notre Dame or they're talking about going to Rome and, you know, I just, I can't, I can't really, I don't really have anything to say. I don't really have that kind of a life and it's not very exciting. So sometimes I might say stuff about that and it's a lot of little things, you know, that I just, I find myself saying things that aren't true and trying to just go along with what they're talking about when I don't even know what they're saying. You know, when they talk about fashion or they talk about just different things and I don't know what to do in that situation and I'm just finding myself just making things up and saying things that I think that they want to hear. I don't even know if they believe it. I kind of got the feeling this time that they were kind of calling me out because they were getting an idea of what I had been doing and it was really embarrassing. I feel like I just want to run away from the situation and I don't want to talk to anybody and I just want to break off friendships.""
Therapist: ""So a possible solution to what you consider the inevitable embarrassment if you have to play tennis with them is to just not see them, just not return their calls. Right.""",406.05,429.0
034_024,034,24,2,"Oh yeah. Yeah, definitely.","Therapist: ""So a possible solution to what you consider the inevitable embarrassment if you have to play tennis with them is to just not see them, just not return their calls. Right.""
Patient: ""I don't want them to know that I have a really boring life and that I'm not as smart as they are and I'm not as successful. I don't want them to know that. I'm kind of like a loser compared to all of their exciting things that they do and say. I just don't match up.""
Therapist: ""You feel you can't keep up with them on really so many levels. You talked about travel and fashion and of course now the athletics area with the tennis. So there's a sense of being inadequate when you're with them?""",449.44,452.39
034_026,034,26,4,"I mean, I have. I mean, I don't want to lose my friends, you know. I enjoy being with them, but it's like I'm going to be mortified if I go out there and try to teach them things I don't know. I mean, I guess maybe I can watch some YouTube videos, but They're gonna realize that I've never played and they're gonna realize that they're better than I am. I don't know. I wonder if they'll still accept me if I tell them the truth.","Therapist: ""You feel you can't keep up with them on really so many levels. You talked about travel and fashion and of course now the athletics area with the tennis. So there's a sense of being inadequate when you're with them?""
Patient: ""Oh yeah. Yeah, definitely.""
Therapist: ""So your options here are somewhat restricted, right? Just let them go as friends or go and play tennis and they'll figure out that you might have been making up that story. or I suppose telling them the truth would be an option as well. Have you thought about the different options available?""",489.53,522.84
034_028,034,28,2,"Yeah, but maybe there's a chance if I tell them the truth that they might have some understanding of what I've been doing because I don't even understand it myself, but.","Therapist: ""So your options here are somewhat restricted, right? Just let them go as friends or go and play tennis and they'll figure out that you might have been making up that story. or I suppose telling them the truth would be an option as well. Have you thought about the different options available?""
Patient: ""I mean, I have. I mean, I don't want to lose my friends, you know. I enjoy being with them, but it's like I'm going to be mortified if I go out there and try to teach them things I don't know. I mean, I guess maybe I can watch some YouTube videos, but They're gonna realize that I've never played and they're gonna realize that they're better than I am. I don't know. I wonder if they'll still accept me if I tell them the truth.""
Therapist: ""So you fear you might have lost them either way at this point?""",527.67,540.43
034_030,034,30,2,"Well, it's really when I get really nervous about being around a group or, you know, get around people that I really admire and I feel like I can't match up to them, so. I don't know. It's probably, I probably did it here and there in high school when I was a kid but it's just lately it's been more as I started, you know, I got a new job with this really big company and I have more responsibility and I got promoted so I'm kind of in circles with people that are really intelligent and successful and you know, financially secure and so it's probably when I get into situations socially with people that I really feel are above me, you know, whether it be socially or just intellectually.","Therapist: ""So you fear you might have lost them either way at this point?""
Patient: ""Yeah, but maybe there's a chance if I tell them the truth that they might have some understanding of what I've been doing because I don't even understand it myself, but.""
Therapist: ""How long has this been going on? Like the exaggeration or less than complete honesty in these social situations?""",556.75,616.16
034_032,034,32,2,"No, not really. It's just really been in these friendship groups. I think with my family, they know me and they know who I am, so I feel comfortable. I take a lot of pride in my job, so I don't do anything there. I'm pretty honest with anyone who's under me and above me, obviously. So it's something that is just this really strange, pressured social situation. I just kind of, I lose all confidence at that point when I'm hearing what other people are doing and how successful they are.","Therapist: ""How long has this been going on? Like the exaggeration or less than complete honesty in these social situations?""
Patient: ""Well, it's really when I get really nervous about being around a group or, you know, get around people that I really admire and I feel like I can't match up to them, so. I don't know. It's probably, I probably did it here and there in high school when I was a kid but it's just lately it's been more as I started, you know, I got a new job with this really big company and I have more responsibility and I got promoted so I'm kind of in circles with people that are really intelligent and successful and you know, financially secure and so it's probably when I get into situations socially with people that I really feel are above me, you know, whether it be socially or just intellectually.""
Therapist: ""So your circle of friends is one group that you've been less than honest with. Any other individuals or groups you've been less than honest with?""",630.36,669.81
034_034,034,34,2,Have I ever been truthful? Only if it's an area that I feel confident in.,"Therapist: ""So your circle of friends is one group that you've been less than honest with. Any other individuals or groups you've been less than honest with?""
Patient: ""No, not really. It's just really been in these friendship groups. I think with my family, they know me and they know who I am, so I feel comfortable. I take a lot of pride in my job, so I don't do anything there. I'm pretty honest with anyone who's under me and above me, obviously. So it's something that is just this really strange, pressured social situation. I just kind of, I lose all confidence at that point when I'm hearing what other people are doing and how successful they are.""
Therapist: ""So I wonder, has there ever been a situation where you're with your friends and they're kind of doing what you described where they're talking about their accomplishments and you have chosen to not be less than honest? Like either you made no contribution to the conversation or you made the contribution that was within, that was truthful. Has that ever occurred?""",698.24,705.39
034_040,034,40,4,"It's been great. I mean, it's fine. I guess it works like it's fine. Like they we have good conversation and we get along, we laugh and it's it's I feel I feel comfortable. I get really anxious when I start telling lies like it's it doesn't feel comfortable. and I know I'm telling lies and I'm getting caught up in it and then it's just building and building and building and then I don't even know, I don't even know what I've said anymore. People say things to me sometimes and I'm like, oh yeah, yeah, that's true.","Therapist: ""But only if you start out confident.""
Patient: ""Yeah.""
Therapist: ""How is how's that worked out?""",715.98,751.82
034_046,034,46,2,"I don't know. You know, I think they would think I was, I didn't belong there. I didn't belong with them. You know, that I wasn't really good enough to be their friend. You know, kind of, as I'm saying it out loud, it seems kind of weird to say it out loud. But I guess that's what I'm thinking. I'm thinking that if people see who I really am, You know, they're not going to like it.","Therapist: ""So really, I mean, what you're describing, there's two outcomes to the social situations that occur. One is that you're less than honest and you don't feel good about yourself when you do that. Or if it happens to be an area where you are confident, you can participate in that discussion. But it seems like what you haven't tried is when you're not confident, kind of still being honest. Right, right. Because that's when that sense of inadequacy is really strong for you.""
Patient: ""Yeah.""
Therapist: ""What do you suppose would happen if you weren't as impressive as they were and you relayed that? Like, you know, in the particular area that they're discussing.""",800.03,826.67
034_056,034,56,4,"Well, I feel like I just, like, even with just this situation, I just don't want to be here again. You know, I know that I took this way too far. And at times when people are coming up to me and I don't even remember what I said, I was starting to get that sense. This is the first time that I'm really caught red-handed. And so I'm almost forced at this point to make a decision. And you know, I don't want to hit the nuke button. I don't want to just decide to just disappear from my friendships. And maybe it'll help if I just say, this is what I do sometimes and it's not okay, but I did it this time and I'm sorry. You know, I don't know if I'll end up with any friendships anyway, but.","Therapist: ""And you, you know, no one's good at everything. So you can't always count on having that feeling of confidence. Right. that would allow you to be honest with them and fully engaged in the conversation.""
Patient: ""Right.""
Therapist: ""So, you'll have to decide what to do there, but it seems like it might be worth trying that, right? Trying the honesty route and seeing if that, you know, seeing what feelings come out of that.""",874.57,926.86
034_062,034,62,4,"I'm just not that interesting. I'm not that smart. I'm not that successful. I mean, it's almost like a mantra.","Therapist: ""So that's coming up quickly.""
Patient: ""Yes.""
Therapist: ""I want to touch on the automatic thoughts. We talked about this before. These are the thoughts that come up in the moment when a stressful situation is introduced. And it sounds like the stressful situation in this case is your friends talking about successes or interesting things. What's the thought that pops into your mind in that moment? take yourself to that moment where your friends are talking and you're talking about feeling isolated, but what was the thought that you're thinking?""",1011.15,1019.88
034_066,034,66,1,"I guess it's a matter of perspective, you know. You know, I just got a promotion. So, you know, in terms of success, like I have some, that was something that I just did. But I don't know, like interesting is kind of relative, you know. I don't know what makes somebody interesting over another person, you know.","Therapist: ""I'm not that successful. I'm not that interesting. I'm not that smart. So really all automatic thoughts that are putting it down.""
Patient: ""Yeah.""
Therapist: ""Are those automatic thoughts defensible? Is that realistic?""",1041.45,1067.11
034_080,034,80,1,Yeah. Because there might be other topics that I know a lot about.,"Therapist: ""Not that you may not be as interesting on this particular topic.""
Patient: ""Right.""
Therapist: ""But just, you're not interesting. All the way over to one side.""",1117.36,1122.1
034_086,034,86,2,"I have been to other places, too. It's just, you know, Europe sounds so much more exotic and interesting than the places I've been, you know. So.","Therapist: ""But it's not like you're... completely isolated from travel.""
Patient: ""Right.""
Therapist: ""And you've been to other places.""",1148.56,1157.91
034_088,034,88,2,"Yeah. That's silly to feel like I have to be on top of everything all the time. So no, I don't have to dominate the conversation all the time. It doesn't always have to be about how interesting Maria is.","Therapist: ""And you've been to other places.""
Patient: ""I have been to other places, too. It's just, you know, Europe sounds so much more exotic and interesting than the places I've been, you know. So.""
Therapist: ""Yes, you're not completely out of the discussion. It's just on that one topic of world travel. Right. And do you always have to have the most interesting stories about or even equally interesting stories about what they're talking about.""",1179.4,1196.3
034_092,034,92,2,"Yeah. Yeah. I mean, because I should be able to just be myself. especially in a friend group. I definitely want to stop doing this. You want to stop?","Therapist: ""And if it's not true, then I mean, this is something you're doing to fit in better with this group, but these statements aren't true. Right. So it hasn't really changed anything about you except that you were less than honest with them.""
Patient: ""Right. Right.""
Therapist: ""And maybe that's for some of these feelings of now, like you seem like you're regretting these decisions.""",1225.58,1240.89
034_096,034,96,3,"Well, I definitely don't need to be the center of attention all the time. You know, it's okay to be learning and getting something out of somebody else's adventures rather than always presenting myself forward. I mean, it's exhausting. Especially trying to come up with things and stuff starts coming out of my mouth. I don't even know what I'm saying, so it's exhausting. You know, once in a while it might be nice to just learn and hear and appreciate my friend, you know, and just kind of be there.","Therapist: ""Yeah. Yeah, this is causing you stress and anxiety, right?""
Patient: ""Yeah.""
Therapist: ""So, notwithstanding the hard choices you have to make with this particular situation, I'd like to put a plan together to help you with this in general. I don't know what the best choice for you is in terms of your friends. Yeah. It's difficult and really only you can make it. I'm certainly open to talking through the possible consequences and your feelings about it if you want to meet again before Saturday. But that kind of put aside for a second. You're aware of the automatic thoughts that are coming in. Yeah. realize your cognition. And I wonder if we could build, and this could be kind of like a homework assignment, if you could build what we call some adaptive responses. We talk about the self-talk. So these are the thoughts we consciously think to really counter the automatic thoughts. And I guess I've touched on some of my thinking in terms of adaptive responses, like is it okay to be somewhat interesting? Do you have to be the most interesting in the conversation? More of interest to me than what I was thinking is, what are your ideas on some adaptive responses to these thoughts?""",1331.96,1360.03
034_102,034,102,1,"Yeah, I don't... I think that's it. I don't always have to be the center of attention. I don't always have to be the one with the most interesting story in the group.","Therapist: ""I don't always have to impress.""
Patient: ""Yeah.""
Therapist: ""Or something like that. Yeah. I want to be in your own words.""",1392.97,1402.37
034_104,034,104,2,And I just want to be able to be me with my friend group and be accepted for the non-traveling me. Yeah. Sure. So.,"Therapist: ""Or something like that. Yeah. I want to be in your own words.""
Patient: ""Yeah, I don't... I think that's it. I don't always have to be the center of attention. I don't always have to be the one with the most interesting story in the group.""
Therapist: ""And further, this may... avoid an uncomfortable situation, like being less than honest, but it's exhausting to you. Yeah. So there's consequences that are unpleasant for them.""",1417.64,1427.6
034_106,034,106,4,"Well, not feeling successful, you know. I sometimes just have to remind myself of what I've done so far. And, I mean, I'm always feeling like I have to move forward and do more. But, you know.","Therapist: ""And further, this may... avoid an uncomfortable situation, like being less than honest, but it's exhausting to you. Yeah. So there's consequences that are unpleasant for them.""
Patient: ""And I just want to be able to be me with my friend group and be accepted for the non-traveling me. Yeah. Sure. So.""
Therapist: ""It's okay not to travel. Any other ideas for adaptive responses?""",1437.57,1453.62
034_108,034,108,3,"Yeah. Yeah. Yeah. Because at that moment, I think I forget. And then I just want to top their success. But, you know, I know I've done okay for myself. It's just at that moment, I got to get really caught up in just the feeling that I'm not good enough. Because I immediately compare myself to that person and what they've done.","Therapist: ""It's okay not to travel. Any other ideas for adaptive responses?""
Patient: ""Well, not feeling successful, you know. I sometimes just have to remind myself of what I've done so far. And, I mean, I'm always feeling like I have to move forward and do more. But, you know.""
Therapist: ""All right. So that would be, like, they've just said something impressive. So the thought would be, that was pretty impressive, but I've had successes, too.""",1464.33,1492.09
034_114,034,114,2,"Right, yeah. I definitely struggle with that.","Therapist: ""How do you compare your promotion to somebody that traveled?""
Patient: ""Right.""
Therapist: ""Two completely different things. Right. I'm not sure there's a calculation that makes those so you can compare them, right? Right. So some of this is about self-esteem.""",1516.99,1521.85
034_116,034,116,4,"Yeah, I think I'm gonna think about it and think about what I want to say to them. I think it would be worse for me to try to play and just keep this farce going. I don't think I can keep doing that. I think I'm just, I think I'll have a panic attack right on the court. This won't work. It's a little immature to think I'm just going to shut them off completely as friends at this point.","Therapist: ""Two completely different things. Right. I'm not sure there's a calculation that makes those so you can compare them, right? Right. So some of this is about self-esteem.""
Patient: ""Right, yeah. I definitely struggle with that.""
Therapist: ""Do you want to try to meet before Saturday that we can discuss?""",1528.99,1558.21
034_120,034,120,2,"Yeah, definitely need to stop doing that.","Therapist: ""All right. Well, I want you to think about that. And if you want, we can schedule another appointment before Saturday so we can process that. Okay. So in the meantime, I'm kind of working on the larger problem that you brought up today. How about identifying to the best of your ability, identifying those automatic thoughts we talked about.""
Patient: ""Okay.""
Therapist: ""As they happen, if they happen during this week, but also maybe identifying some of the ones in the past like you've talked about. Yeah. And working with the thought record to build those adaptive responses. Okay. So it's something that you, you know, to adapt the responses, it's something you want to become a habit. You want to have those responses ready to go. So when that thought comes in, before you act on that thought, Yeah. you can, inject that adaptive response, that self-talk. You can talk to yourself and avoid the behavior that you're trying to avoid, which in this case would be the less than honest.""",1624.7,1627.57
034_124,034,124,3,That would be great. I really appreciate it.,"Therapist: ""All right, so does that homework sound manageable?""
Patient: ""Yeah, I can do that.""
Therapist: ""So if you can get a few of those kind of written up, the automatic thoughts and the adaptive responses. And then we can try to get you scheduled in before Saturday.""",1645.33,1648.09
035_006,035,6,2,"Yes, yes.","Therapist: ""I'm okay. You're okay?""
Patient: ""Yeah.""
Therapist: ""I know last time we talked about the fear of driving that you have. We talked about some of the feelings behind it. I know those were strong for you, that fear.""",38.8,40.9
035_014,035,14,2,"Well, I can see it just kind of looking at it.","Therapist: ""Right? So, I know that even talking about this could be a little stressful, so if anything happens where If it gets too much just let me know and we'll stop for a little while and when you feel comfortable we'll start again.""
Patient: ""Okay.""
Therapist: ""All right? Does that sound okay? So can you think of any activities involving a car that right off the bat you kind of know where they are on a scale of one to ten?""",175.47,180.32
035_016,035,16,1,"Yeah, out of the window of the house doesn't bother me too much.","Therapist: ""All right? Does that sound okay? So can you think of any activities involving a car that right off the bat you kind of know where they are on a scale of one to ten?""
Patient: ""Well, I can see it just kind of looking at it.""
Therapist: ""Like out of the window?""",183.2,187.44
035_020,035,20,1,"Yeah, it doesn't bother me. And when I go out with getting the mail and stuff, I have to walk by it. Okay. So that's like a one, too.","Therapist: ""So that's like a one?""
Patient: ""I would say it's a one.""
Therapist: ""Okay, so looking at the car.""",194.59,206.48
035_022,035,22,1,"Well, I don't walk close to it. I just kind of walk on the grass to get to the mailbox, but that distance I feel okay.","Therapist: ""Okay, so looking at the car.""
Patient: ""Yeah, it doesn't bother me. And when I go out with getting the mail and stuff, I have to walk by it. Okay. So that's like a one, too.""
Therapist: ""Walking by it? Yeah. Okay. So walking by the car. You would say a one or two?""",218.02,226.48
035_026,035,26,2,A few times I've had to get closer to it when my kid's old. be playing and the ball go under or close near it. That's like a three.,"Therapist: ""Okay, that's more like a one?""
Patient: ""Like a one.""
Therapist: ""Okay. How about walking a bit closer to it?""",236.51,246.63
035_032,035,32,2,I would say that's probably like a five.,"Therapist: ""Okay, so walking close to the car.""
Patient: ""Yeah.""
Therapist: ""That's a three. How about reaching out and touching it?""",265.21,267.71
035_040,035,40,1,"Because I feel like I know I'm going to get in, so I'd give that like a seven.","Therapist: ""It's different?""
Patient: ""Yeah.""
Therapist: ""What would that be?""",285.94,292.09
035_044,035,44,2,Yeah.,"Therapist: ""A seven?""
Patient: ""Yeah.""
Therapist: ""Okay. So that's really scary for you.""",296.17,298.66
035_046,035,46,2,Probably seven leaning more towards the eight. Yeah.,"Therapist: ""Okay. So that's really scary for you.""
Patient: ""Yeah.""
Therapist: ""How about sitting in the car? in the driver's seat?""",307.02,312.57
035_050,035,50,1,That's not too bad. I can do that. Probably about like a seven.,"Therapist: ""Okay. That's the driver's side, so seven or eight.""
Patient: ""Yeah.""
Therapist: ""How about sitting on the passenger side?""",321.44,325.67
035_058,035,58,1,Probably about a six because I know I won't have to be in control of driving it.,"Therapist: ""And how about opening the passenger door? Opening the door on the driver's side, that's a seven.""
Patient: ""Yeah.""
Therapist: ""How about the passenger door?""",345.47,351.12
035_062,035,62,1,That's a nine. That's a nine? I know what happens next.,"Therapist: ""Yeah. Okay. So driver door seven, passenger door six.""
Patient: ""Yeah.""
Therapist: ""All right. How about on the driver's side, starting the car?""",367.89,371.03
035_064,035,64,2,"Uh-huh, turning it on and yeah.","Therapist: ""All right. How about on the driver's side, starting the car?""
Patient: ""That's a nine. That's a nine? I know what happens next.""
Therapist: ""All right, so that's really getting close to the top. Kind of up there, yeah. Okay, so that's really scary. I can hear everything, yeah. You can hear the engine?""",382.67,387.56
035_066,035,66,2,"Not for a while. Yeah. Yeah, not for a while.","Therapist: ""All right, so that's really getting close to the top. Kind of up there, yeah. Okay, so that's really scary. I can hear everything, yeah. You can hear the engine?""
Patient: ""Uh-huh, turning it on and yeah.""
Therapist: ""Have you ever started a car And just backed it up the driveway? Or just put it in gear?""",395.18,400.93
035_068,035,68,2,Probably still with that nine. Still the nine? Yeah. Okay.,"Therapist: ""Have you ever started a car And just backed it up the driveway? Or just put it in gear?""
Patient: ""Not for a while. Yeah. Yeah, not for a while.""
Therapist: ""Do you know where that would rate?""",404.17,407.92
035_072,035,72,2,"Um, that would probably be about a, I think like an eight, because I'd still be having to move the car and be in control of where it goes and everything.","Therapist: ""All right, so how, you told me this before, like your drive to work. You drive through your neighborhood for a little bit, when you used to drive to work, and then on the interstate for a little bit, on the highway.""
Patient: ""Yeah, yeah.""
Therapist: ""So, how about driving just in the neighborhood?""",436.46,447.55
035_076,035,76,1,"Yeah, because that's the way I take on my bike when I go to work and everything.","Therapist: ""So that would be lower than starting it.""
Patient: ""But I feel safe in my neighborhood.""
Therapist: ""You feel safer?""",453.4,458.61
035_078,035,78,1,"Yeah, because I know which ways I can go and the least amount of traffic or least amount of people walking. and everything to get through.","Therapist: ""You feel safer?""
Patient: ""Yeah, because that's the way I take on my bike when I go to work and everything.""
Therapist: ""Okay. So from starting the car, that's a nine. Driving it is still pretty distressing, but it's a little bit lower.""",467.62,478.35
035_080,035,80,4,That's definitely a 10. That's a 10? Yeah. That's a 10.,"Therapist: ""Okay. So from starting the car, that's a nine. Driving it is still pretty distressing, but it's a little bit lower.""
Patient: ""Yeah, because I know which ways I can go and the least amount of traffic or least amount of people walking. and everything to get through.""
Therapist: ""Okay. How about driving it on the highway?""",485.85,489.75
035_082,035,82,4,"Yeah. Yes. Especially at night or early, early morning. That's extreme.","Therapist: ""Okay. How about driving it on the highway?""
Patient: ""That's definitely a 10. That's a 10? Yeah. That's a 10.""
Therapist: ""So that's pretty much the worst it gets, driving on the highway.""",495.16,503.41
035_084,035,84,2,"On the highway, it's still bad. Because it's just so many things that can happen. But the night is probably worse for me. Okay.","Therapist: ""So that's pretty much the worst it gets, driving on the highway.""
Patient: ""Yeah. Yes. Especially at night or early, early morning. That's extreme.""
Therapist: ""So the daytime Not quite as bad as night.""",509.92,522.36
035_086,035,86,1,It's on the same key chain as my house key. I think it's like a three.,"Therapist: ""So the daytime Not quite as bad as night.""
Patient: ""On the highway, it's still bad. Because it's just so many things that can happen. But the night is probably worse for me. Okay.""
Therapist: ""So we have quite a few activities. Putting the car in gear. Starting the car. Driving on the highway. Driving the neighborhood. All sevens. eights, nines, and tens, like all really stressful. Right. On the lower side, we have walking up to the car, touching the car, a little less stressful. How about grabbing the keys?""",558.5,566.02
035_088,035,88,2,"Yeah, because I have to do it anyway to get in and out.","Therapist: ""So we have quite a few activities. Putting the car in gear. Starting the car. Driving on the highway. Driving the neighborhood. All sevens. eights, nines, and tens, like all really stressful. Right. On the lower side, we have walking up to the car, touching the car, a little less stressful. How about grabbing the keys?""
Patient: ""It's on the same key chain as my house key. I think it's like a three.""
Therapist: ""That's a three?""",567.32,570.84
035_090,035,90,2,Am I in it or I'm watching them through the window?,"Therapist: ""That's a three?""
Patient: ""Yeah, because I have to do it anyway to get in and out.""
Therapist: ""How about if you're not going to be driving the car, but you see someone else start it?""",583.58,585.62
035_092,035,92,2,Probably about Like a four.,"Therapist: ""How about if you're not going to be driving the car, but you see someone else start it?""
Patient: ""Am I in it or I'm watching them through the window?""
Therapist: ""Yeah, you could be watching them through the window.""",592.77,596.52
035_098,035,98,2,"Yeah. I struggle with both, really, but definitely driving is a lot of factors.","Therapist: ""What's more stressful for you, being a passenger or being a driver?""
Patient: ""Driving, definitely.""
Therapist: ""Driving is definitely worse.""",612.39,619.74
035_100,035,100,2,"Definitely driving on the highway in traffic. It's hard, yeah.","Therapist: ""Driving is definitely worse.""
Patient: ""Yeah. I struggle with both, really, but definitely driving is a lot of factors.""
Therapist: ""That's a lot more stressful. Yeah, yeah. All right. Can you think of any other activities with the car that would present a level of distress for you? Anything else that you do with it? Any other way you have to deal with it, like opening the trunk, opening the hood, anything like that?""",651.05,658.65
035_102,035,102,4,"Yeah. Even when it's like, you know, since it's winter, it's getting darker around like 5 and 6. It's usually the time I'm on my way home. And so having to maneuver through traffic, it's about, it's a 10. It's definitely about a 10. If it could be over, I'd push it over.","Therapist: ""That's a lot more stressful. Yeah, yeah. All right. Can you think of any other activities with the car that would present a level of distress for you? Anything else that you do with it? Any other way you have to deal with it, like opening the trunk, opening the hood, anything like that?""
Patient: ""Definitely driving on the highway in traffic. It's hard, yeah.""
Therapist: ""So like at night in traffic would be the worst?""",662.38,681.89
035_106,035,106,4,"Yeah, and that's kind of the rush hour with everyone getting home. So that's really hard.","Therapist: ""Okay. Yeah, that's all, yeah. All right, so that's really... Yeah. That's really causing you stress.""
Patient: ""Yeah.""
Therapist: ""Yeah, really fearful.""",689.85,698.22
035_108,035,108,1,"Well, I definitely feel safer in the SUV because I have more around me. With the car, I see everything around. Just people, I feel like they're closer and more can happen with the car. But with the SUV, I feel protected more because it has more room. It definitely has more room, more around it. I'm higher up. so I can see ahead more, as well as I can see behind me better than I would with a car. And our car, it's a really short and small car, so we barely have trunk space in the back, so anything could happen, it could just crunch us. So I think with the SUV, it's a lot more room, and it's a lot more protecting me.","Therapist: ""Yeah, really fearful.""
Patient: ""Yeah, and that's kind of the rush hour with everyone getting home. So that's really hard.""
Therapist: ""You mentioned when we talked before that you have this car, but there's also like a large SUV that on occasion you drive. How does operating that vehicle or interacting with that vehicle rate compared to the car?""",717.64,765.56
035_110,035,110,1,"Yeah. Because just the setup of an SUV feels safer to me. I feel like I can get in and I have so much around me that can stop me from, if an accident was to happen, it would hit those areas first before it would get to me. Yeah. So I definitely think it would be lower.","Therapist: ""You mentioned when we talked before that you have this car, but there's also like a large SUV that on occasion you drive. How does operating that vehicle or interacting with that vehicle rate compared to the car?""
Patient: ""Well, I definitely feel safer in the SUV because I have more around me. With the car, I see everything around. Just people, I feel like they're closer and more can happen with the car. But with the SUV, I feel protected more because it has more room. It definitely has more room, more around it. I'm higher up. so I can see ahead more, as well as I can see behind me better than I would with a car. And our car, it's a really short and small car, so we barely have trunk space in the back, so anything could happen, it could just crunch us. So I think with the SUV, it's a lot more room, and it's a lot more protecting me.""
Therapist: ""So would you say for a number of the ratings that we've done here for the car, that you would be one or two points lower for an SUV. I think that's fair. Yeah. So pretty much anything you could do with the car, you're going to feel a little bit better about doing that with the SUV.""",786.49,804.02
035_114,035,114,4,So closer? A little closer?,"Therapist: ""It would be a lower level of distress.""
Patient: ""Yeah.""
Therapist: ""All right. So I think we have broken down enough levels where we can work from 1 to 10 without making any large jumps. Okay. So what I'd like to do to kind of get things started before next session is to have you attempt a couple of the ones. We had two, looking at the car and walking kind of by the car.""",847.87,849.97
035_120,035,120,1,"Yeah, I definitely could see myself doing that.","Therapist: ""So looking at the car from your house through the window. and then walking kind of past it but not being too close to it.""
Patient: ""Okay.""
Therapist: ""Those are two activities that you rated as a one. Do you still feel like they're ones?""",867.16,869.98
035_124,035,124,2,"Okay. I'm doing it in the daytime, right?","Therapist: ""So let's start with just those two activities, looking at it and then walking by it but leaving a fair distance.""
Patient: ""Okay.""
Therapist: ""And record kind of how that felt, what your thoughts were as you did it, what the outcome was.""",888.04,890.55
035_126,035,126,1,"Yeah. I think I can definitely do that because, like I said, I have to go get the mail, and I have to walk past it to go into work and everything. So I definitely think I could try those things.","Therapist: ""And record kind of how that felt, what your thoughts were as you did it, what the outcome was.""
Patient: ""Okay. I'm doing it in the daytime, right?""
Therapist: ""You can do it in the daytime. Okay. I want to start at the lowest level of stress. Okay. All right, so that seems like it would be not particularly stressful compared to the other activities.""",902.99,915.61
036_005,036,5,5,"Yeah, I still panic when I take them.","Therapist: ""I'm doing well, thanks for asking. How have things been going?""
Patient: ""They've been alright, up and down.""
Therapist: ""Last time we were talking, it sounded like you were still having some difficulty with the quizzes. Is that still the case?""",33.14,36.01
036_007,036,7,2,So I'm going to class. I'm fine. I sit down to take the test. I'm fine. The test is in front of me. Question one. I'm not going to get that answer.,"Therapist: ""Last time we were talking, it sounded like you were still having some difficulty with the quizzes. Is that still the case?""
Patient: ""Yeah, I still panic when I take them.""
Therapist: ""You still panic? Can you tell me about the process of taking the quizzes? I know we touched on this a little bit before.""",43.9,51.33
036_013,036,13,2,No. It's happened in previous online classes. It's the same.,"Therapist: ""Like a paper pencil? Mm-hmm. Okay. With other students around?""
Patient: ""Yes.""
Therapist: ""All right. Is having other students around distracting to you?""",65.12,68.0
036_017,036,17,4,What are you thinking? reading the question and I'm thinking oh my god there's okay there's four okay so it's got to be it's got to be one of them and I am NOT gonna pick the right one I'm gonna think I picked the right one and it's gonna be the one of my second choices and I am NOT gonna pick the right one okay so your thought is that you're gonna get you're gonna suck the wrong response and therefore get that quiz item wrong how about,"Therapist: ""All right. So you're pretty sure it's the quiz itself and not some external. Mm-hmm. So it's paper and pencil. You're seated. You're in the room. The room's relatively distraction-free.""
Patient: ""Yeah. Yeah, everybody's quiet.""
Therapist: ""All right. And you're looking down at really the first item on the quiz. And what's happening then as you look down and you read that first item? We'll start at a thought level. What's happening?""",99.15,128.42
036_019,036,19,2,"I'd say my palms are probably sweaty. Like, I'm probably a little tense.","Therapist: ""All right. And you're looking down at really the first item on the quiz. And what's happening then as you look down and you read that first item? We'll start at a thought level. What's happening?""
Patient: ""What are you thinking? reading the question and I'm thinking oh my god there's okay there's four okay so it's got to be it's got to be one of them and I am NOT gonna pick the right one I'm gonna think I picked the right one and it's gonna be the one of my second choices and I am NOT gonna pick the right one okay so your thought is that you're gonna get you're gonna suck the wrong response and therefore get that quiz item wrong how about""
Therapist: ""behavior? Like, do you notice anything physically going on as you're thinking about that quiz item and how you're going to get it wrong?""",141.0,148.13
036_021,036,21,2,Yeah. That's really it.,"Therapist: ""behavior? Like, do you notice anything physically going on as you're thinking about that quiz item and how you're going to get it wrong?""
Patient: ""I'd say my palms are probably sweaty. Like, I'm probably a little tense.""
Therapist: ""A little tense?""",149.01,152.83
036_023,036,23,2,"It starts all over again. I'm already like, well, I already got the first one wrong and now my chances are higher of getting this one wrong.","Therapist: ""A little tense?""
Patient: ""Yeah. That's really it.""
Therapist: ""Alright, so what it could be is that this thought of, I'm going to get this item wrong is leading to these uncomfortable feelings, the physical feelings. All right. So what happens when you answer item one? Like you don't know if you have it right or wrong immediately, right? Because it's a paper and pencil. So you answer item one and you move on to item two. What happens then?""",181.93,187.8
036_027,036,27,4,"If I get one wrong the whole test, it's all going to be wrong.","Therapist: ""So you feel like it... because you thought that you got the first one wrong, that your chances of getting the second one wrong actually increase.""
Patient: ""Yeah.""
Therapist: ""Okay.""",200.56,204.17
036_033,036,33,2,"Throughout the time, yes.","Therapist: ""But eventually you're going to come to one item that you're going to have these doubts about.""
Patient: ""Yes. Inevitably it happens.""
Therapist: ""There's going to be one that's maybe a little more difficult or difficult for you. So it seems like what you're saying is that when you reach that item where you have that thought, from that point on, the next item is more difficult because you're having a similar thought. Does that pattern continue?""",242.21,245.56
036_035,036,35,4,"It just compounds. I feel worse and worse as the quiz, as I continue.","Therapist: ""There's going to be one that's maybe a little more difficult or difficult for you. So it seems like what you're saying is that when you reach that item where you have that thought, from that point on, the next item is more difficult because you're having a similar thought. Does that pattern continue?""
Patient: ""Throughout the time, yes.""
Therapist: ""All right. So explain to me, let's just go with the example of the first item, just to keep it more simple. So you have the first item, and that didn't work out for you. You had that thought, right? The second one, your thought was, I have even a greater chance of missing. So what happens after you respond to that second item?""",267.12,273.25
036_037,036,37,4,"I'm convinced I'm, it's over, I've gotten a zero. If it's the, yeah, if I start at the first, I've gotten a zero, I've gotten a bad grade.","Therapist: ""All right. So explain to me, let's just go with the example of the first item, just to keep it more simple. So you have the first item, and that didn't work out for you. You had that thought, right? The second one, your thought was, I have even a greater chance of missing. So what happens after you respond to that second item?""
Patient: ""It just compounds. I feel worse and worse as the quiz, as I continue.""
Therapist: ""That's awful. That's an awful feeling for you, right? So by the time you get to item five or six.""",280.42,286.58
036_039,036,39,3,"If it like, if it's, if it like starts early at the beginning of the test, my heart's like pounding at this point, but I still have the sweaty palms, I'm still like tensing.","Therapist: ""That's awful. That's an awful feeling for you, right? So by the time you get to item five or six.""
Patient: ""I'm convinced I'm, it's over, I've gotten a zero. If it's the, yeah, if I start at the first, I've gotten a zero, I've gotten a bad grade.""
Therapist: ""All right, so that's what's on your mind. Yeah, and how about those physical symptoms? Are they the same, different, are there new symptoms?""",296.35,305.87
036_041,036,41,2,I've been a pretty solid B student so and I feel I wish I did better I wish I got A's but I mean B's are fine but when I take those quizzes it's not it doesn't I don't know how it translates.,"Therapist: ""All right, so that's what's on your mind. Yeah, and how about those physical symptoms? Are they the same, different, are there new symptoms?""
Patient: ""If it like, if it's, if it like starts early at the beginning of the test, my heart's like pounding at this point, but I still have the sweaty palms, I'm still like tensing.""
Therapist: ""So it really just gets mentally and physically more unpleasant for you the whole time. So when you're saying panic, the panic's really occurring a few items in after you have the first one that you thought you missed. And this has been happening for a while, as you described, right? Yeah. Well, how about your grades? How have you actually been doing on the quizzes?""",337.6,359.59
036_043,036,43,1,"I've taken workshops on studying. I think I'm pretty effective at studying. I've found what doesn't work, so I try to study by reading the chapters, taking outlines, reviewing flashcards, which has, I think, the best results.","Therapist: ""So it really just gets mentally and physically more unpleasant for you the whole time. So when you're saying panic, the panic's really occurring a few items in after you have the first one that you thought you missed. And this has been happening for a while, as you described, right? Yeah. Well, how about your grades? How have you actually been doing on the quizzes?""
Patient: ""I've been a pretty solid B student so and I feel I wish I did better I wish I got A's but I mean B's are fine but when I take those quizzes it's not it doesn't I don't know how it translates.""
Therapist: ""How about your study habits? Do you consider yourself effective at studying?""",366.36,387.47
036_049,036,49,1,"Yeah, that's absolutely right.","Therapist: ""But you're still having these distressing thoughts and these uncomfortable physical sensations when you take the quizzes.""
Patient: ""Yeah.""
Therapist: ""Is that about right?""",406.81,409.44
036_053,036,53,1,"Yeah, because I got B's, like I said. Yeah.","Therapist: ""So really, you don't necessarily need your performance to change. You just need your thoughts and feelings and behaviors to change.""
Patient: ""Yeah.""
Therapist: ""So how are you reacting to the quizzes, maybe?""",429.38,432.55
036_057,036,57,2,"It means once I don't get that right, I'm not going to get anything else right.","Therapist: ""And B is good. Yeah. All right, so I want to take you back to the moment when you're looking at the first item. Let's go back to that for a second, okay? So you're taking a quiz, and... you're having those thoughts surrounding that first item, which if I'm not mistaken, the automatic thought, we talked about this, right, with the cognitive behavioral therapy, the automatic thought is that I'm not going to get this one right or something to that effect.""
Patient: ""Right.""
Therapist: ""What does that mean to you?""",478.22,481.09
036_059,036,59,4,"The whole thing, yeah.","Therapist: ""What does that mean to you?""
Patient: ""It means once I don't get that right, I'm not going to get anything else right.""
Therapist: ""So what that thought means to you is that you're going to miss that item and then you're going to miss all the rest of the items. So you're going to fail the whole quiz.""",496.27,499.73
036_061,036,61,5,"It just gets worse. If I fail the quiz, then I'm like, oh my God, I'm going to fail the final. I'm going to fail the course. And that's going to affect my GPA.","Therapist: ""So what that thought means to you is that you're going to miss that item and then you're going to miss all the rest of the items. So you're going to fail the whole quiz.""
Patient: ""The whole thing, yeah.""
Therapist: ""So looking at that, let's call that an intermediate belief, right? It's more of a rule or an expectation, right? What does that mean to you?""",514.48,524.21
036_065,036,65,4,I can't. I can't be a teacher. I can't do what I want to do.,"Therapist: ""So it just keeps stacking, right? So we have other beliefs. So you're going to fail the course, or you're going to fail the final, rather. Then you're going to fail the course. So if you failed the course, what would that mean to you?""
Patient: ""That I'm not going to graduate.""
Therapist: ""you're not going to graduate. So we've moved from failing the quiz, if we just look at the meaning, right, to failing the final, to failing the course, and now to not graduating. So if you didn't graduate, what would that mean to you?""",563.81,565.89
036_069,036,69,4,I don't know who I'd be at that point. That's what I always saw as my career. So I don't know what my future would look like at that point without that.,"Therapist: ""So your chosen vocation to be a teacher would be not possible.""
Patient: ""Right.""
Therapist: ""Right. So we go a step further and say, what would it mean to you if you couldn't be a teacher?""",580.7,591.53
036_072,036,72,4,"I am a person who didn't make it. I'm a person that failed, like we said earlier.","Patient: ""I don't know who I'd be at that point. That's what I always saw as my career. So I don't know what my future would look like at that point without that.""
Therapist: ""So if you were to phrase it and kind of think back to the CBT techniques kind of conceptualization we've covered. If you were to phrase that as an I am statement, what would you be if you couldn't be a teacher?""
Therapist: ""What would that make you?""",623.37,629.74
036_076,036,76,2,"I didn't think about it like that until we did the step up to it now, but I can relate to that. Because a lot of times I do feel like, oh, I'm not going to be able to do this. Because it's me, I won't be able to do it.","Therapist: ""I'm a person who didn't make it, I'm a person who failed. So in a way you're saying, I'm a failure. Right? Is that close?""
Patient: ""Yeah.""
Therapist: ""So remember we talked before about core beliefs and how these core beliefs drive these intermediate beliefs which combine with situations like in your case taking a quiz. to form these automatic thoughts. So one of your core beliefs may be that you're a failure. You may believe that. Does that seem like something that you've said to yourself before or thought before?""",678.93,696.15
036_082,036,82,2,"It must be. Because, like I said, I study. I get good grades. I've been tested years ago. I don't have ADHD, anything intrinsic that would prohibit me.","Therapist: ""So you're saying to yourself at a variety of levels, I'm going to be unsuccessful, I'm going to fail. Does that make sense?""
Patient: ""Yeah.""
Therapist: ""And you think that's what's happening?""",721.05,734.41
036_084,036,84,4,"Yes, yes. I can do all of that. But when it comes to it, I'm like, I can't do it.","Therapist: ""And you think that's what's happening?""
Patient: ""It must be. Because, like I said, I study. I get good grades. I've been tested years ago. I don't have ADHD, anything intrinsic that would prohibit me.""
Therapist: ""So you're able to focus and concentrate well.""",736.77,741.86
036_086,036,86,2,"I don't think they would see the connection. I think they would be like, well, you do well in school, I don't understand.","Therapist: ""So you're able to focus and concentrate well.""
Patient: ""Yes, yes. I can do all of that. But when it comes to it, I'm like, I can't do it.""
Therapist: ""So somewhere, somewhere is this this core belief, and it's possible that it has something to do with you believing that you are a failure, unsuccessful. Yeah. How do you think your, say, friends or family would interpret that? Like if, and I'm not suggesting, telling them that, but if they were to somehow know that, that you believed you were a failure, how would they react?""",779.79,787.79
036_092,036,92,1,"I guess I'd say the same thing that my family would say, like, look at the evidence, you're not a failure.","Therapist: ""You may believe it.""
Patient: ""Yeah, yeah.""
Therapist: ""Right. And similarly, if you had a classmate that was in the same situation and, you know, struggled with these disturbing thoughts and feelings and behaviors during quizzes, How would you evaluate them?""",819.42,824.69
036_104,036,104,2,"I guess that in my past quizzes, chances are I have a good chance of getting it right.","Therapist: ""That just pops in your head, right?""
Patient: ""Okay.""
Therapist: ""This one would be one that you deliberately think. So what could you think to yourself that would be a counter to that automatic thought that you're having that you're going to get that item wrong?""",925.21,931.47
036_126,036,126,2,"Right. On paper, technically, I'm not, but I... still, I guess, feel that way.","Therapist: ""So in a way, cognitively, you're...""
Patient: ""There's that discrepancy.""
Therapist: ""Right. There's a little bit of both. You can tell me that your family would say that's not the case, but you still...""",1114.6,1119.82
036_132,036,132,1,"Yeah, I can do that.","Therapist: ""So I want you to weigh the validity of that core belief. Okay. Right? And actually I think with this it's helpful to write down evidence that would support it, right? And that's certainly something to note, but also And this is really more important, evidence that refutes it. Okay. Evidence that runs counter.""
Patient: ""Right.""
Therapist: ""But record both. And we'll meet next time and we'll look at the evidence. Okay. And we'll evaluate it.""",1161.83,1164.94
036_134,036,134,1,"Yeah, they do. They do. I definitely think I can do those.","Therapist: ""But record both. And we'll meet next time and we'll look at the evidence. Okay. And we'll evaluate it.""
Patient: ""Yeah, I can do that.""
Therapist: ""So those two steps you feel like you're comfortable with and they make sense to you.""",1172.27,1176.28
037_006,037,6,2,"Okay, so I've had an issue that started about when I was a little bit younger. When I was about 10 years old, I was really active, I was playing outside all the time, and my neighbors had large dogs. that were always in their yard, they would always be outside running around. And we were separated by a fence and if I was playing outside or like kicking a ball around or doing anything with a friend and I had to go after the ball, it would be near the fence. And especially if I wasn't looking, I'd be leaning down to grab the ball or just have my back turned. And they would come up, they would be really excited, and they would jump on the fence. And I never would be expecting it, and they would always startle me. And I would always feel this sense of fear and uneasiness around them. And so I've kind of always been a little bit more uncomfortable around dogs since all of that happened.","Therapist: ""I'm doing well. Thanks for asking. I know that the last time we spoke, we talked about spending today's session working on units of distress, these different levels, these different exercises that cause increasingly more stress around this specific phobia you have. And I know you mentioned it related to a dog, but I didn't get a lot of information last time about how that kind of all forms, so I was hoping we could start there with kind of what happened that made you afraid of this dog.""
Patient: ""Sure, sure.""
Therapist: ""Tell me about that.""",62.96,123.39
037_014,037,14,4,"Yeah, it was like a whole body reaction, I guess, because I wouldn't ever be looking. I wouldn't know that they were coming, and then they would just be up against the fence, like barking and jumping, and I felt like they were going to jump over and try to get me.","Therapist: ""You were around 10.""
Patient: ""Yeah.""
Therapist: ""And they would startle you? Would you, like, jump?""",133.4,148.26
037_016,037,16,4,"Yeah, yeah, because there's an incident that happened more recently at my friend's house, and it was a really big problem. I was at a party last weekend, and they had a bunch of people outside. The dog was out loose, and it's there, and so it's never really a problem. It's always kind of around. It doesn't really come near me. I can always just kind of keep my distance from it. but we were outside and they were playing with it and I wasn't really paying attention and they were throwing the frisbee for the dog between each other and the dog was facing me and I turned around and it was running towards me and I didn't realize it and I just saw him coming up at me just kind of like how the dogs had when I was a kid and it really was unexpected and it startled me and I kind of thought Like when I was a kid, they were going to come get me even though he didn't. He didn't come near me. And it was a really big problem for me because I was all shaken up, and I tried to go inside and calm myself down, and I couldn't, and I had to leave. I had to leave the house. And I've been really uncomfortable ever since.","Therapist: ""And they would startle you? Would you, like, jump?""
Patient: ""Yeah, it was like a whole body reaction, I guess, because I wouldn't ever be looking. I wouldn't know that they were coming, and then they would just be up against the fence, like barking and jumping, and I felt like they were going to jump over and try to get me.""
Therapist: ""And since that time, you haven't been a big fan of dogs, no? Not really. And for this exercise, specifically, there was one dog in particular that you wanted to... kind of work through that fear?""",165.03,240.92
037_018,037,18,2,It was a full-grown German Shepherd. Yeah. His name is Thor.,"Therapist: ""And since that time, you haven't been a big fan of dogs, no? Not really. And for this exercise, specifically, there was one dog in particular that you wanted to... kind of work through that fear?""
Patient: ""Yeah, yeah, because there's an incident that happened more recently at my friend's house, and it was a really big problem. I was at a party last weekend, and they had a bunch of people outside. The dog was out loose, and it's there, and so it's never really a problem. It's always kind of around. It doesn't really come near me. I can always just kind of keep my distance from it. but we were outside and they were playing with it and I wasn't really paying attention and they were throwing the frisbee for the dog between each other and the dog was facing me and I turned around and it was running towards me and I didn't realize it and I just saw him coming up at me just kind of like how the dogs had when I was a kid and it really was unexpected and it startled me and I kind of thought Like when I was a kid, they were going to come get me even though he didn't. He didn't come near me. And it was a really big problem for me because I was all shaken up, and I tried to go inside and calm myself down, and I couldn't, and I had to leave. I had to leave the house. And I've been really uncomfortable ever since.""
Therapist: ""So this was particularly stressful, this particular dog. What kind of dog is it?""",246.32,250.69
037_022,037,22,4,"Yeah, because I've been really hesitant to go back over there because her family, it's my good friend, so her family's super nice, and they said, like, you know, we'll lock the dog up, like, you can still come over. But... I would just feel really guilty because it's their house and I'm over there, well, I used to be over there all the time. And now if I go over there, that means that they have to keep the dog, like, away or, you know, not really where I can, like, be near it because I'm going to have that fear.","Therapist: ""His name is Thor?""
Patient: ""Yeah.""
Therapist: ""And you want to be able to interact specifically with Thor? You want to be able to conquer that fear?""",261.45,292.92
037_024,037,24,1,"Yeah, yeah, they're so nice. So definitely if I said, like, can you help me with this, they would totally be involved with me.","Therapist: ""And you want to be able to interact specifically with Thor? You want to be able to conquer that fear?""
Patient: ""Yeah, because I've been really hesitant to go back over there because her family, it's my good friend, so her family's super nice, and they said, like, you know, we'll lock the dog up, like, you can still come over. But... I would just feel really guilty because it's their house and I'm over there, well, I used to be over there all the time. And now if I go over there, that means that they have to keep the dog, like, away or, you know, not really where I can, like, be near it because I'm going to have that fear.""
Therapist: ""All right, so it's important for you to go over the specific fear and the owners of the dog you think will cooperate with the exercise that we have here.""",303.75,310.8
037_038,037,38,1,"Okay. Yeah, that would probably be A one. A one? Yeah. Okay. That wouldn't be too much.","Therapist: ""Okay, it doesn't have to be the first one's one, the next one's two. I might have some that go backwards or that don't register at all. Okay.""
Patient: ""All right. Yep.""
Therapist: ""All right, so how let's start with something I believe will be mild, which would be if I were to, like, for example, with this pen and this paper, draw a German shepherd. So it would be a crude drawing.""",437.62,445.04
037_040,037,40,2,That would be probably a three or a four.,"Therapist: ""All right, so how let's start with something I believe will be mild, which would be if I were to, like, for example, with this pen and this paper, draw a German shepherd. So it would be a crude drawing.""
Patient: ""Okay. Yeah, that would probably be A one. A one? Yeah. Okay. That wouldn't be too much.""
Therapist: ""How about if I took a picture, like with a cell phone, of a German Shepherd, but it was out of focus, and I showed you that picture?""",456.47,460.36
037_044,037,44,1,"Um... That would probably be a 5. Yeah, if I could see it, that would be a 5.","Therapist: ""That would be a three or a four?""
Patient: ""Yeah.""
Therapist: ""What if I took a picture that was of any German Shepherd that was clear?""",469.77,476.87
037_054,037,54,1,"Yeah, I would say that's probably a four, three or four. Yeah, it would, because he'd be far away from me.","Therapist: ""He'd be far away in the picture. Like, so he's, like, I picture some, like, a big yard you're describing. Okay, yeah. I'd say I'm way back.""
Patient: ""Okay, okay.""
Therapist: ""It'd be six if he was, like, right in the, like, close up.""",511.97,517.74
037_056,037,56,1,"Just thinking about him, probably just a two.","Therapist: ""It'd be six if he was, like, right in the, like, close up.""
Patient: ""Yeah, I would say that's probably a four, three or four. Yeah, it would, because he'd be far away from me.""
Therapist: ""Okay. How about if I ask you to think about a German Shepherd in general, just bringing up a mental image?""",529.09,531.61
037_062,037,62,1,But still around the same. Not too much.,"Therapist: ""And thinking about Thor specifically?""
Patient: ""Maybe a three.""
Therapist: ""Maybe a three.""",539.61,541.69
037_072,037,72,2,"Maybe a little bit more nervous, like a three, but still, yeah.","Therapist: ""How about if I had a larger German Shepherd stuffed animal, like one that was maybe approximated?""
Patient: ""Near me?""
Therapist: ""Yeah, like in the, yeah, like here.""",570.9,574.0
037_074,037,74,2,"Yeah, yeah. Not too scary.","Therapist: ""Yeah, like in the, yeah, like here.""
Patient: ""Maybe a little bit more nervous, like a three, but still, yeah.""
Therapist: ""You kind of know it's a stuffed animal.""",575.14,577.21
037_078,037,78,2,Probably like a four or a five.,"Therapist: ""It's not really triggering anything.""
Patient: ""Yeah.""
Therapist: ""All right. How about if I was able to obtain a cell phone video of Thor, but I only played the sound for you, like him barking?""",596.13,598.92
037_080,037,80,1,"Yeah, with the sound or no sound?","Therapist: ""All right. How about if I was able to obtain a cell phone video of Thor, but I only played the sound for you, like him barking?""
Patient: ""Probably like a four or a five.""
Therapist: ""A four or five?""",600.56,602.68
037_086,037,86,2,"Yeah, to see him and to hear him at the same time. Yeah, that'd make me a little bit more nervous.","Therapist: ""Okay. So picture that same, like I'm holding a cell phone. I've played a video of Thor running and barking. Okay. But you've only heard the sound because the screen's facing me. That same scenario, except I show you the video.""
Patient: ""That would probably be six.""
Therapist: ""That'd be a six.""",629.55,633.28
037_088,037,88,2,Probably a five. A five.,"Therapist: ""That'd be a six.""
Patient: ""Yeah, to see him and to hear him at the same time. Yeah, that'd make me a little bit more nervous.""
Therapist: ""What if I showed you the video, but I kept the sound off?""",642.93,644.93
037_096,037,96,2,"Okay. So I know he's there, but he's behind the door.","Therapist: ""And in the yard.""
Patient: ""Okay.""
Therapist: ""So say you're there at the house. And he's there, but he's in a bedroom, and the door's closed, and you know that that door will remain closed.""",688.58,691.05
037_098,037,98,1,Okay. Yeah. That would probably be about seven. Seven. Yeah.,"Therapist: ""So say you're there at the house. And he's there, but he's in a bedroom, and the door's closed, and you know that that door will remain closed.""
Patient: ""Okay. So I know he's there, but he's behind the door.""
Therapist: ""Yeah, and I imagine he'd be barking.""",693.39,701.84
037_104,037,104,2,"Okay. Now that I can see him, it would probably be about 8. 8? Yeah.","Therapist: ""And there's a post or a tree in the back, and he's chained. So you can see him, you can hear him.""
Patient: ""Okay.""
Therapist: ""He's chained up, and there's a window separating him.""",726.71,733.58
037_106,037,106,2,"Yeah, that would be a little bit more intense, so probably about a 9. Yeah, 9.","Therapist: ""He's chained up, and there's a window separating him.""
Patient: ""Okay. Now that I can see him, it would probably be about 8. 8? Yeah.""
Therapist: ""How about that same situation I just described, except he's running loose in the backyard. So he could be right up to the window, but he can't get to you.""",740.5,746.43
037_108,037,108,2,"Yeah, that would probably be the same. That would probably be a 9 too.","Therapist: ""How about that same situation I just described, except he's running loose in the backyard. So he could be right up to the window, but he can't get to you.""
Patient: ""Yeah, that would be a little bit more intense, so probably about a 9. Yeah, 9.""
Therapist: ""And what if you're in the backyard with him? I know that's a 10 if he's just there in the backyard, but you're in the backyard, and let's say he's chained and he clearly can't reach you, but there's no window between you.""",763.91,765.97
037_110,037,110,2,"And I know that she's not going to let go of him? Yeah, like, yeah. Okay. Yeah, it'd be a little less worse, so probably about a seven or an eight, I would think.","Therapist: ""And what if you're in the backyard with him? I know that's a 10 if he's just there in the backyard, but you're in the backyard, and let's say he's chained and he clearly can't reach you, but there's no window between you.""
Patient: ""Yeah, that would probably be the same. That would probably be a 9 too.""
Therapist: ""9? Yeah. that same situation in the backyard with him, except instead of chained, the owner's like holding him maybe like by the collar or something, like keeping him from running towards him.""",779.28,792.54
037_112,037,112,2,"Yeah, definitely. The chain could break or something like that. All right.","Therapist: ""9? Yeah. that same situation in the backyard with him, except instead of chained, the owner's like holding him maybe like by the collar or something, like keeping him from running towards him.""
Patient: ""And I know that she's not going to let go of him? Yeah, like, yeah. Okay. Yeah, it'd be a little less worse, so probably about a seven or an eight, I would think.""
Therapist: ""Okay, so you have more confidence with the owner holding the dog than, like, with the chain.""",799.76,803.4
037_114,037,114,1,"No. No, I think those kind of cover everything that would make me nervous in the situation that I was in.","Therapist: ""Okay, so you have more confidence with the owner holding the dog than, like, with the chain.""
Patient: ""Yeah, definitely. The chain could break or something like that. All right.""
Therapist: ""Yeah. Are there any other levels kind of moving toward the sphere that you can think of that you want me to add?""",815.62,822.74
037_126,037,126,1,"Yeah, I think that's great. I think that will definitely help.","Therapist: ""And we may think of other steps I can put in there, like driving up to the house but not going in. So we'll try to, if it's too much of a jump, We'll try to minimize that.""
Patient: ""Okay. Okay, great.""
Therapist: ""Does that sound like a good plan?""",932.63,934.99
038_006,038,6,4,"Yeah. Stu and I were talking about it before I came in and I can't really figure out why I'm so bothered. We have such a great relationship. I mean, I feel lucky as a woman in the 21st century to have a man who cares about her and takes her out and makes her feel appreciated. I've never had that before. And I go home happy. I go home excited to see him. I can't name a single friend or even my sisters who have that. And... Still, all I hear is their criticisms, their words, how weird it is, and why would a 58-year-old man want to be with you? You're not even 30 yet. And I just don't see that. I don't see age being an issue, but again, I'm waking up with those thoughts.","Therapist: ""I'm good. Thanks for asking.""
Patient: ""Sure.""
Therapist: ""So, I know last time we talked, you had just touched on this relationship you're in and how it has led to some concerns and some people's feedback has led to concerns. You want to talk about that today?""",45.59,105.57
038_008,038,8,4,"Yeah, my mom and my sister, they haven't gotten any better since you and I spoke last. They text me all the time, and I just try to not play into it. I just, you know, play civil because it's not their life. I don't live there anymore. But the coworkers, that's gotten worse, I think, in that more people are talking about it. It's almost like it's gossip. And that's just not my thing. I don't like being in anyone's business. No one should be in mine. And, you know, love is love. Why should it be a topic for discussion at work? I don't know.","Therapist: ""So, I know last time we talked, you had just touched on this relationship you're in and how it has led to some concerns and some people's feedback has led to concerns. You want to talk about that today?""
Patient: ""Yeah. Stu and I were talking about it before I came in and I can't really figure out why I'm so bothered. We have such a great relationship. I mean, I feel lucky as a woman in the 21st century to have a man who cares about her and takes her out and makes her feel appreciated. I've never had that before. And I go home happy. I go home excited to see him. I can't name a single friend or even my sisters who have that. And... Still, all I hear is their criticisms, their words, how weird it is, and why would a 58-year-old man want to be with you? You're not even 30 yet. And I just don't see that. I don't see age being an issue, but again, I'm waking up with those thoughts.""
Therapist: ""So the criticisms come from a few of your family members, and you had mentioned some people at work, too.""",115.47,159.0
038_010,038,10,4,"They think it's bizarre, for sure.","Therapist: ""So the criticisms come from a few of your family members, and you had mentioned some people at work, too.""
Patient: ""Yeah, my mom and my sister, they haven't gotten any better since you and I spoke last. They text me all the time, and I just try to not play into it. I just, you know, play civil because it's not their life. I don't live there anymore. But the coworkers, that's gotten worse, I think, in that more people are talking about it. It's almost like it's gossip. And that's just not my thing. I don't like being in anyone's business. No one should be in mine. And, you know, love is love. Why should it be a topic for discussion at work? I don't know.""
Therapist: ""So their area of focus is really just the age difference.""",164.0,166.55
038_012,038,12,3,"I think so. I don't even know what that limit would be. I mean, I'm 29. You know, I've been living on my own. I can make my own decisions. I've had a job for who knows how long. I'm a capable woman. Like, it's not... I don't think that should be a measure of me being weird or he being weird just because we're together.","Therapist: ""So their area of focus is really just the age difference.""
Patient: ""They think it's bizarre, for sure.""
Therapist: ""they feel it's over some socially accepted limit?""",173.74,197.91
038_016,038,16,2,"I mean, maybe. They make fun of him because they think he's too old to come to the bar with us. I play tennis, as you know, so they think he's going to fall and break his leg or something if he plays with me.","Therapist: ""Just that age difference, that shouldn't be a factor.""
Patient: ""It should not be a factor.""
Therapist: ""And they're not criticizing any other elements of the relationship.""",207.25,220.28
038_018,038,18,3,"It is. I don't know. And this is why at the beginning, I don't know why these things are infiltrating so deeply. I mean, it's been a great year with him and you know, I'm still, like I said, I'm still really happy. but I just don't, I don't get it. I mean, I want their acceptance, but I want this relationship too. And I'm thinking, I don't know if I can have both because I just feel pushed further away and he's great. He's great, but he's not my family, you know?","Therapist: ""And they're not criticizing any other elements of the relationship.""
Patient: ""I mean, maybe. They make fun of him because they think he's too old to come to the bar with us. I play tennis, as you know, so they think he's going to fall and break his leg or something if he plays with me.""
Therapist: ""So they're still kind of on the age subject. Yeah. So that really seems to be their... primary concern is they're giving you advice or criticizing all the things they're doing. So we've talked before and there's been other issues where you've received criticism from family members and even coworkers. You've been conscientious and you've examined it and just kind of accepted it and moved on. This is a little different for you though.""",254.38,295.29
038_020,038,20,4,I definitely feel like I'm being forced to choose right now.,"Therapist: ""So they're still kind of on the age subject. Yeah. So that really seems to be their... primary concern is they're giving you advice or criticizing all the things they're doing. So we've talked before and there's been other issues where you've received criticism from family members and even coworkers. You've been conscientious and you've examined it and just kind of accepted it and moved on. This is a little different for you though.""
Patient: ""It is. I don't know. And this is why at the beginning, I don't know why these things are infiltrating so deeply. I mean, it's been a great year with him and you know, I'm still, like I said, I'm still really happy. but I just don't, I don't get it. I mean, I want their acceptance, but I want this relationship too. And I'm thinking, I don't know if I can have both because I just feel pushed further away and he's great. He's great, but he's not my family, you know?""
Therapist: ""All right. So there's, there's kind of a part where you feel like you're, you're being forced to choose.""",301.25,304.08
038_022,038,22,2,"I mean, honestly, I think about it, you know. Because I think what we have, Stu and I, is great. But are we going to get married? Is he going to want to have kids? Do I want to have kids? I don't even know if I want to be a wife. He's been married before. Maybe he doesn't want to do that. But what if he doesn't want to do that? But I do. I don't know. I haven't figured these things out yet. And I think that's part of why I'm listening... to these criticisms more because maybe they're right. Maybe I don't have my head on right about this.","Therapist: ""All right. So there's, there's kind of a part where you feel like you're, you're being forced to choose.""
Patient: ""I definitely feel like I'm being forced to choose right now.""
Therapist: ""So that's one of the problems. Do you have any concerns, whether they were generated from outside advice or criticism, do you have any concerns about the age difference yourself?""",322.92,370.88
038_024,038,24,3,"Yeah, and it's great to hide behind a strong relationship when you don't necessarily have those things figured out because you just go out and you have fun. But thinking about it right now, Yeah, I don't know. I don't have any definitive priorities, really, aside from keeping my job, I guess.","Therapist: ""So that's one of the problems. Do you have any concerns, whether they were generated from outside advice or criticism, do you have any concerns about the age difference yourself?""
Patient: ""I mean, honestly, I think about it, you know. Because I think what we have, Stu and I, is great. But are we going to get married? Is he going to want to have kids? Do I want to have kids? I don't even know if I want to be a wife. He's been married before. Maybe he doesn't want to do that. But what if he doesn't want to do that? But I do. I don't know. I haven't figured these things out yet. And I think that's part of why I'm listening... to these criticisms more because maybe they're right. Maybe I don't have my head on right about this.""
Therapist: ""They're definitive, right? So they have a clear direction. Whereas you're still a bit confused.""",378.77,400.41
038_026,038,26,2,"Yeah, we haven't necessarily talked too deeply about that. We joke about things like that, but...","Therapist: ""They're definitive, right? So they have a clear direction. Whereas you're still a bit confused.""
Patient: ""Yeah, and it's great to hide behind a strong relationship when you don't necessarily have those things figured out because you just go out and you have fun. But thinking about it right now, Yeah, I don't know. I don't have any definitive priorities, really, aside from keeping my job, I guess.""
Therapist: ""So maybe part of the solution is talking with him and figuring out how your goals might align with his goals. That seems to be a concern of yours.""",415.13,421.72
038_028,038,28,2,"In a serious manner, yeah, we haven't.","Therapist: ""So maybe part of the solution is talking with him and figuring out how your goals might align with his goals. That seems to be a concern of yours.""
Patient: ""Yeah, we haven't necessarily talked too deeply about that. We joke about things like that, but...""
Therapist: ""So there maybe hasn't been a serious discussion yet where you've really talked about the age difference and how it could play out?""",430.88,436.35
038_032,038,32,4,"That's a lot. That's a lot. Yeah, I don't know.","Therapist: ""I mean, you may not know this, but has he received criticism in a similar way? Yeah. So this is maybe something he could understand because he's going through it too. Very much. So ultimately, I suppose, you have to make a decision, not right now, but eventually you have to make a decision about what to do with this relationship.""
Patient: ""I know. I know.""
Therapist: ""And there's many factors that weigh into this, right? So you have your values, what you want for your future, your co-worker's relationship with you, your family's relationship with you, his relationship with you. All these things come together.""",481.8,484.34
038_034,038,34,2,"I know the feeling, absolutely, yeah.","Therapist: ""And there's many factors that weigh into this, right? So you have your values, what you want for your future, your co-worker's relationship with you, your family's relationship with you, his relationship with you. All these things come together.""
Patient: ""That's a lot. That's a lot. Yeah, I don't know.""
Therapist: ""There's a lot of factors to weigh. Yeah. Sometimes when a relationship is new, there's like a period it goes through where kind of love is in the air, so to speak, right? And sometimes facts don't get weighed as heavily. You familiar with what I'm talking about there?""",510.44,513.32
038_036,038,36,4,"I think the veil has been taken off. I think, you know, we've said I love you to each other, but that rosy kind of honeymoon phase, it's definitely... going away. It's showing itself to be a messier situation, I think.","Therapist: ""There's a lot of factors to weigh. Yeah. Sometimes when a relationship is new, there's like a period it goes through where kind of love is in the air, so to speak, right? And sometimes facts don't get weighed as heavily. You familiar with what I'm talking about there?""
Patient: ""I know the feeling, absolutely, yeah.""
Therapist: ""Where do you feel that you are in terms of that?""",519.49,546.53
038_038,038,38,3,"I don't know how, but I know I have to. I think that's why I just wanted to talk to you about this, because I have to figure out a system to write it down and just make sense of it.","Therapist: ""Where do you feel that you are in terms of that?""
Patient: ""I think the veil has been taken off. I think, you know, we've said I love you to each other, but that rosy kind of honeymoon phase, it's definitely... going away. It's showing itself to be a messier situation, I think.""
Therapist: ""So you feel like you're able to look at it realistically now as you weigh the present cons?""",553.86,565.39
038_040,038,40,4,"Definitely. The pressure is much more now as I'm starting to realize, you know, there are lots of layers to this that maybe didn't exist when it was all fun and games at the beginning.","Therapist: ""So you feel like you're able to look at it realistically now as you weigh the present cons?""
Patient: ""I don't know how, but I know I have to. I think that's why I just wanted to talk to you about this, because I have to figure out a system to write it down and just make sense of it.""
Therapist: ""Yes, some process that allows you to come to the conclusion that works best for you, which may mean staying with them, and may mean not staying with them. Or somewhere in between, where you have a relationship that's... where there's not a full commitment to be with one another, but you still see them. I mean, I guess there's a lot of shades of gray here available, but you're kind of being pressed to figure that out. And you're feeling that pressure to figure that out.""",597.9,610.54
038_042,038,42,5,"I have no idea. I don't know. You know, I've talked with one of my best friends about it, but really it's just such a weird... thing in society that people just don't understand it and i've got close friends that have stuck by me i've had so many friends leave because they think what i'm doing is just totally inappropriate um and i i don't know who to talk to about it really because aside from you anyone i talk to just it's like instantly they have a judgment and they know better So I've tried that. I keep a diary, so I talk about that and talk to Stu about it. But it just seems like it gets bigger the more I think and try to work on it. And then I just walk away and kind of give up.","Therapist: ""Yes, some process that allows you to come to the conclusion that works best for you, which may mean staying with them, and may mean not staying with them. Or somewhere in between, where you have a relationship that's... where there's not a full commitment to be with one another, but you still see them. I mean, I guess there's a lot of shades of gray here available, but you're kind of being pressed to figure that out. And you're feeling that pressure to figure that out.""
Patient: ""Definitely. The pressure is much more now as I'm starting to realize, you know, there are lots of layers to this that maybe didn't exist when it was all fun and games at the beginning.""
Therapist: ""So how do you make a calculation like this?""",613.69,665.37
038_046,038,46,2,"If it was okay, I think I would just be asking the normal questions. Like, do we have a future together? You know, should we buy a place together? You know, the stuff that I think most girlfriends and boyfriends ask. But this just becomes so much murkier because I don't know if I'm making a decision because he's older than me or, you know, because people see him as maybe not being good for me or his friends seeing me not being good for him. Like, I'm just taking into account everyone's judgments. So I think if that was off the table, It would just be easier. I'd have decisions to make, but it would just be so much easier.","Therapist: ""Give up for a while.""
Patient: ""Yeah.""
Therapist: ""So, yeah, this age difference issue is certainly one where you would expect to get strong reactions one way or the other. Right. So somebody is really okay with it, and others are very strongly against it, maybe somewhere in the middle. But it's a polarizing issue. So I'm curious, so if there was... If the larger kind of attitude in society toward these age differences was that it was fine, how would that affect your decision-making process?""",702.71,746.73
038_048,038,48,3,"Yeah, like I have. I mean, I've come to you about so many things, and we just work through it, and I accept it, and I kind of use it as a building block. But this is just, like I said, it's messy.","Therapist: ""So, yeah, this age difference issue is certainly one where you would expect to get strong reactions one way or the other. Right. So somebody is really okay with it, and others are very strongly against it, maybe somewhere in the middle. But it's a polarizing issue. So I'm curious, so if there was... If the larger kind of attitude in society toward these age differences was that it was fine, how would that affect your decision-making process?""
Patient: ""If it was okay, I think I would just be asking the normal questions. Like, do we have a future together? You know, should we buy a place together? You know, the stuff that I think most girlfriends and boyfriends ask. But this just becomes so much murkier because I don't know if I'm making a decision because he's older than me or, you know, because people see him as maybe not being good for me or his friends seeing me not being good for him. Like, I'm just taking into account everyone's judgments. So I think if that was off the table, It would just be easier. I'd have decisions to make, but it would just be so much easier.""
Therapist: ""You'd still have to work through it, but you could manage that process.""",750.21,760.26
038_054,038,54,2,And go over it piece by piece and make sense of it.,"Therapist: ""So maybe we start here, and you mentioned this earlier about writing things down.""
Patient: ""Yeah.""
Therapist: ""Again... how one makes these calculations is really, it's just up to the individual. But what you could do is maybe write down some of the areas that are definitively positive, like things you like about the relationship and where it's going and where it could go. At the same time, definitively negative, some of the areas that are going to be challenges. And maybe a column for challenges or opportunities that you just don't know how to categorize. Neutral or maybe slightly negative or slightly positive, but you're just unsure about. And maybe some of those areas are the ones more influenced by people's criticisms, because those judgments have made this harder. So if you were to go home and just use that system, like just three columns, that which you have really figured out is good, that which you know is going to be tough. I know getting around it. And those areas where you just really would like to work harder to try to figure out if they should be categorized as good or bad, or maybe they just stay as just neutral items. Maybe that can help inform the next session. We can kind of talk through your list. Sure.""",844.03,846.57
038_056,038,56,2,"Yeah, I'll start it tonight, I think, and just visit it throughout the day for the next week. You know what I mean? Each day. Just kind of keep it, maybe even travel with it in my bag or something. Yeah, right, because even, like, even every day is different. Like, if he and I get in a fight, you know, how we fight, and that might be a pro or a con, you know. So, yeah, I can definitely do that.","Therapist: ""Again... how one makes these calculations is really, it's just up to the individual. But what you could do is maybe write down some of the areas that are definitively positive, like things you like about the relationship and where it's going and where it could go. At the same time, definitively negative, some of the areas that are going to be challenges. And maybe a column for challenges or opportunities that you just don't know how to categorize. Neutral or maybe slightly negative or slightly positive, but you're just unsure about. And maybe some of those areas are the ones more influenced by people's criticisms, because those judgments have made this harder. So if you were to go home and just use that system, like just three columns, that which you have really figured out is good, that which you know is going to be tough. I know getting around it. And those areas where you just really would like to work harder to try to figure out if they should be categorized as good or bad, or maybe they just stay as just neutral items. Maybe that can help inform the next session. We can kind of talk through your list. Sure.""
Patient: ""And go over it piece by piece and make sense of it.""
Therapist: ""Yeah, and I would hope, too, as you write these things down, it's not just a matter of recording information. It's also a process where it might get you thinking about different aspects, and you may look at that list, maybe you do that tonight or tomorrow night, and you may look at that list a few days from now and say, well, I'm going to move this item over to a different column, because it's made you think about it more. Yeah, this is something I agree, this is something you really have to sit with.""",874.29,897.49
038_058,038,58,2,"Yeah, it's just, I know we could be having fun, I think, if I didn't have to worry about this as much, you know. And... Maybe this will help me make a decision that's actually better for everybody. That doesn't include us being together in this capacity. So we'll see. And I think I just have to grow, you know, to accept that.","Therapist: ""Yeah, and I would hope, too, as you write these things down, it's not just a matter of recording information. It's also a process where it might get you thinking about different aspects, and you may look at that list, maybe you do that tonight or tomorrow night, and you may look at that list a few days from now and say, well, I'm going to move this item over to a different column, because it's made you think about it more. Yeah, this is something I agree, this is something you really have to sit with.""
Patient: ""Yeah, I'll start it tonight, I think, and just visit it throughout the day for the next week. You know what I mean? Each day. Just kind of keep it, maybe even travel with it in my bag or something. Yeah, right, because even, like, even every day is different. Like, if he and I get in a fight, you know, how we fight, and that might be a pro or a con, you know. So, yeah, I can definitely do that.""
Therapist: ""Yeah, so it's going to be, you know, rather than a static recording, it's going to be kind of a living document that you work on. And probably after we meet the next time, you'll work on it some more and we'll continue that. Okay. It might make, well, I'd hope it would make this decision a little more clear, but I can see that you're struggling with this. I appreciate how tough it is and that you really brought this in to talk about. I know this can't be fun to talk about. It's really weighing on your mind.""",931.02,956.2
039_007,039,7,4,"Yeah. So in school, um, I am in school for teaching and we have to give presentations a lot as you can imagine, um, on different things. And so it's something that's recurring. And what happened was, um, I gave a really bad one one time.","Therapist: ""I know when we met last time for your intake, you were concerned about some presentations that you had to give at school.""
Patient: ""Yes.""
Therapist: ""You want to talk about that today?""",45.15,70.32
039_009,039,9,4,"Yeah. I wasn't feeling very well, and I gave, I think I was just really tired from studying all night, and I gave a really bad presentation. And then, like, now, ever since, like, when I've tried to give subsequent presentations, I'm just so nervous, and I'm up there, like, sweating, and, like, starting to forget what I'm gonna say, and I'm just, like, a fear of of getting up there and having to get a presentation because I feel like I'm going to vomit.","Therapist: ""You want to talk about that today?""
Patient: ""Yeah. So in school, um, I am in school for teaching and we have to give presentations a lot as you can imagine, um, on different things. And so it's something that's recurring. And what happened was, um, I gave a really bad one one time.""
Therapist: ""A bad presentation?""",72.26,103.92
039_011,039,11,2,"Yeah, I mean like before and earlier in my, like I'm towards the end of my degree so, you know, throughout my program I have, I have.","Therapist: ""A bad presentation?""
Patient: ""Yeah. I wasn't feeling very well, and I gave, I think I was just really tired from studying all night, and I gave a really bad presentation. And then, like, now, ever since, like, when I've tried to give subsequent presentations, I'm just so nervous, and I'm up there, like, sweating, and, like, starting to forget what I'm gonna say, and I'm just, like, a fear of of getting up there and having to get a presentation because I feel like I'm going to vomit.""
Therapist: ""Alright, so was there a time before, like recently, when you had to give presentations?""",113.89,124.12
039_013,039,13,1,"Pretty well. I mean, I consider myself a pretty good student, so normally I do pretty well. It seemed to, you know, come out of nowhere.","Therapist: ""Alright, so was there a time before, like recently, when you had to give presentations?""
Patient: ""Yeah, I mean like before and earlier in my, like I'm towards the end of my degree so, you know, throughout my program I have, I have.""
Therapist: ""Yeah, and how did you deal with those?""",125.98,133.61
039_015,039,15,2,"Yeah, like I was saying, I wasn't feeling very well, I don't think, and it really hasn't happened.","Therapist: ""Yeah, and how did you deal with those?""
Patient: ""Pretty well. I mean, I consider myself a pretty good student, so normally I do pretty well. It seemed to, you know, come out of nowhere.""
Therapist: ""So this presentation that you gave with the, where you received a poor score, maybe just an isolated incident?""",144.52,153.27
039_017,039,17,2,"Oh, yeah. Like I'm worried about my grades suffering as a result and, you know, how well I'm going to do.","Therapist: ""So this presentation that you gave with the, where you received a poor score, maybe just an isolated incident?""
Patient: ""Yeah, like I was saying, I wasn't feeling very well, I don't think, and it really hasn't happened.""
Therapist: ""But that experience has still led to a lot of anxiety with subsequent presentations.""",162.33,170.4
039_019,039,19,2,"Like right now or other times are really just in that moment when you're presenting mostly It's most intense in that moment and like maybe like leading up to it like in Preparation that I know that this is going to happen like I always know when I'm going to present like it'll be like She'll the teacher will say oh well. You know you're this Thursday someone else's next Thursday So the closer it gets to that event, the more anxious I am, like in anticipation.","Therapist: ""But that experience has still led to a lot of anxiety with subsequent presentations.""
Patient: ""Oh, yeah. Like I'm worried about my grades suffering as a result and, you know, how well I'm going to do.""
Therapist: ""All right. So would it be okay if we kind of step through the whole process of you giving a presentation? Yeah, sure. All right. Before I start with that is this something that leads to anxiety?""",189.31,219.11
039_021,039,21,1,"Yeah, I would say a few days mostly.","Therapist: ""All right. So would it be okay if we kind of step through the whole process of you giving a presentation? Yeah, sure. All right. Before I start with that is this something that leads to anxiety?""
Patient: ""Like right now or other times are really just in that moment when you're presenting mostly It's most intense in that moment and like maybe like leading up to it like in Preparation that I know that this is going to happen like I always know when I'm going to present like it'll be like She'll the teacher will say oh well. You know you're this Thursday someone else's next Thursday So the closer it gets to that event, the more anxious I am, like in anticipation.""
Therapist: ""Okay, so you start feeling anxiety a few days before presentation?""",225.48,228.62
039_023,039,23,4,"Like two days before or one day before. Then I'm like, oh my gosh, like am I ready? Like what if I mess up? You know, what if I get a bad grade? All these like what ifs.","Therapist: ""Okay, so you start feeling anxiety a few days before presentation?""
Patient: ""Yeah, I would say a few days mostly.""
Therapist: ""When does it start to get really distressing for you?""",233.55,242.06
039_031,039,31,2,"I would say, like, am I prepared enough? Like, did I do enough, you know, to study or to write down? Did I do enough?","Therapist: ""All right. So, let's now move to two days out. Okay. Where you would start to feel a little anxiety about it.""
Patient: ""Yeah.""
Therapist: ""What's going through your mind at that two-day out point?""",290.38,301.05
039_033,039,33,2,"Yeah, which leads to maybe I didn't, is what I'm really thinking. Like, I'm not prepared enough as I should be.","Therapist: ""What's going through your mind at that two-day out point?""
Patient: ""I would say, like, am I prepared enough? Like, did I do enough, you know, to study or to write down? Did I do enough?""
Therapist: ""All right. So your thought is, did I do enough preparation?""",307.06,314.29
039_039,039,39,2,"So at that point I'm usually like more like anxious, maybe like irritable a little bit, um, mostly.","Therapist: ""All right. So that's the thought you're having about 48 hours before the presentation. I'm not prepared enough.""
Patient: ""Yeah.""
Therapist: ""And kind of thinking about that thought, and what happens afterward. Do you have a reaction, like any type of emotional affect, affective reaction to that?""",341.88,351.94
039_041,039,41,4,"Um, like the day before it like kind of gets more intense when I'm like nitpicking like well I forgot this or I didn't forget this and you know remembering what happened last time when I didn't do so well and worrying about my grade like more thoughts pop in my head of things that I forgot or what if sort of things right so the same type of thought just more intense more intense and the feeling","Therapist: ""And kind of thinking about that thought, and what happens afterward. Do you have a reaction, like any type of emotional affect, affective reaction to that?""
Patient: ""So at that point I'm usually like more like anxious, maybe like irritable a little bit, um, mostly.""
Therapist: ""And that goes substantially unchanged, that feeling, for how long?""",358.93,389.88
040_001,040,1,4,yes it's really hard so like when I'm in the middle of being worried I'm it's really hard for me to focus so I can't focus on like what I need to do because I feel like my mind is on a lot of different things and I can't focus on you know exactly what I should be doing it's just like I'm worried about you know all the different aspects all right so your ability to,"Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Does the feeling itself, the worry about not being prepared, interfere with preparing?""",35.88,65.03
040_003,040,3,4,Yeah. To like focus my energy on the right things. I'm just like wasting time worrying.,"Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Does the feeling itself, the worry about not being prepared, interfere with preparing?""
Patient: ""yes it's really hard so like when I'm in the middle of being worried I'm it's really hard for me to focus so I can't focus on like what I need to do because I feel like my mind is on a lot of different things and I can't focus on you know exactly what I should be doing it's just like I'm worried about you know all the different aspects all right so your ability to""
Therapist: ""concentrate and do the hard work of preparing.""",67.99,73.24
040_005,040,5,4,Yeah. And then like while I'm presenting. Alright.,"Therapist: ""concentrate and do the hard work of preparing.""
Patient: ""Yeah. To like focus my energy on the right things. I'm just like wasting time worrying.""
Therapist: ""Alright, so this this excessive worrying and all this interfering and preparing all this goes on right up until you're getting ready to present?""",90.75,93.75
040_009,040,9,1,It depends on the presentation. Sometimes there's like one or two other people that have to present that night. depending on how long the topic is.,"Therapist: ""So let's talk about that. Let's go into the actual day of presenting. So we have this excessive work coming in. It's interfering with your ability to prepare. It's distressing for you. Yeah. Now it's in class. These presentations are in class.""
Patient: ""Yeah.""
Therapist: ""So you're in the classroom. Are you the only one to present during that class or does it rotate through several people?""",118.66,125.52
040_011,040,11,2,"Um... The one... Well, the one that I really messed up, I think that was first. But usually, like, I'm like second, maybe.","Therapist: ""So you're in the classroom. Are you the only one to present during that class or does it rotate through several people?""
Patient: ""It depends on the presentation. Sometimes there's like one or two other people that have to present that night. depending on how long the topic is.""
Therapist: ""Alright, let's use the last time you've presented that class as a tempo. What was the order? Like, what order did you go in there?""",134.33,143.6
040_017,040,17,4,"I feel like I am totally zoned out. Like I'm not even paying attention to what that person's saying because I'm so worried about how I'm going to mess it up. Um, you know, I'm, I'm starting to like be sweaty, like my hands are clammy, my heart's starting to race a little bit and I'm just totally zoned out on what they're doing. I'm just, you know, worrying about What's gonna happen when I get up there?","Therapist: ""So, you're sitting in the classroom and another student is presenting.""
Patient: ""Yeah.""
Therapist: ""What's going through your mind then?""",157.65,185.59
040_019,040,19,2,"Yes, it's funny you should say that. I was a little bit hesitant to mention that, but I kind of, I do. I feel like I need to find an excuse to like use the bathroom or I just need to get out of there.","Therapist: ""What's going through your mind then?""
Patient: ""I feel like I am totally zoned out. Like I'm not even paying attention to what that person's saying because I'm so worried about how I'm going to mess it up. Um, you know, I'm, I'm starting to like be sweaty, like my hands are clammy, my heart's starting to race a little bit and I'm just totally zoned out on what they're doing. I'm just, you know, worrying about What's gonna happen when I get up there?""
Therapist: ""All right, so in that moment as you're seated You're not really watching their presentation. Yeah as much because you have these strong or Somewhat strong physical symptoms you have your heart racing a bit. You said yeah sweaty palms. You're zoned out Yeah, have you ever felt the? need desire to like run out of the room.""",214.03,223.88
040_021,040,21,2,"Um, I would say that just like my anxiety and my heart rate are starting to increase and I feel like I just need to get out of there.","Therapist: ""All right, so in that moment as you're seated You're not really watching their presentation. Yeah as much because you have these strong or Somewhat strong physical symptoms you have your heart racing a bit. You said yeah sweaty palms. You're zoned out Yeah, have you ever felt the? need desire to like run out of the room.""
Patient: ""Yes, it's funny you should say that. I was a little bit hesitant to mention that, but I kind of, I do. I feel like I need to find an excuse to like use the bathroom or I just need to get out of there.""
Therapist: ""Yeah, so what do you feel is most pressuring you to leave the room? Like what symptom?""",234.19,243.37
040_025,040,25,4,"I think I'm thinking, like, I'm gonna bomb this anyway, so I might as well just, you know, not go through the stress of having to do it. Like, I've already, in my head, I know that it's gonna end badly.","Therapist: ""And what, what thoughts going through your mind right then? Like, so let's take that kind of most severe moment when you're, you're, uh, let's just say we're still before the presentation. Okay. So you're sitting at the desk and your heart rate's elevated and you're not focusing on what they're doing. You're zoned out. Your anxiety's high.""
Patient: ""Yeah.""
Therapist: ""What thought is going through your mind right then?""",267.67,279.54
040_027,040,27,4,"Right, so there's no sense in getting up there, and maybe if I don't get up there, you know, I guess it couldn't be any worse, so I might as well just leave.","Therapist: ""What thought is going through your mind right then?""
Patient: ""I think I'm thinking, like, I'm gonna bomb this anyway, so I might as well just, you know, not go through the stress of having to do it. Like, I've already, in my head, I know that it's gonna end badly.""
Therapist: ""So I've already, I've already failed.""",282.57,292.56
040_029,040,29,2,"Yeah. I don't want, I figure if I leave then people won't, will just maybe think I was sick or whatever and it'll be a better situation if I just left than having to see me up there, you know, sweating and all this, these other symptoms that I have when I actually get up there. It would be better just to leave before that starts.","Therapist: ""So I've already, I've already failed.""
Patient: ""Right, so there's no sense in getting up there, and maybe if I don't get up there, you know, I guess it couldn't be any worse, so I might as well just leave.""
Therapist: ""Are you... embarrassed that the professor or other students will see that you were really anxious?""",306.43,324.76
040_031,040,31,4,"Yeah, or have them wonder what happened than to just be up in front of everybody, you know.","Therapist: ""Are you... embarrassed that the professor or other students will see that you were really anxious?""
Patient: ""Yeah. I don't want, I figure if I leave then people won't, will just maybe think I was sick or whatever and it'll be a better situation if I just left than having to see me up there, you know, sweating and all this, these other symptoms that I have when I actually get up there. It would be better just to leave before that starts.""
Therapist: ""Okay. So better to be thought ill that you just had to leave because you were sick.""",331.33,338.45
040_041,040,41,2,"Right, and I'm looking at the clock and saying, you know, like, how much more time in this presentation before I have to go? Like, should I go? Should I not go? What are the consequences of running out? You know, and kind of playing out which would be worse.","Therapist: ""What happens there? So we're maybe, what, 15 minutes before you present?""
Patient: ""Yeah.""
Therapist: ""So tell me about that. So you have that thought, you want to flee.""",365.24,379.25
040_043,040,43,2,"Um, once I went to the bathroom to try to like calm myself down or talk to myself or, you know, like cool off my face. Um, but I came back.","Therapist: ""So tell me about that. So you have that thought, you want to flee.""
Patient: ""Right, and I'm looking at the clock and saying, you know, like, how much more time in this presentation before I have to go? Like, should I go? Should I not go? What are the consequences of running out? You know, and kind of playing out which would be worse.""
Therapist: ""Have you ever had to run out?""",382.79,394.54
040_047,040,47,4,Yeah. I almost felt like I was going to be ill. I was so stressed that day.,"Therapist: ""And you presented.""
Patient: ""Yeah. And then I presented.""
Therapist: ""All right. So you, you survived one of the more stressful.""",403.43,407.15
040_049,040,49,5,"So typically, like, I go to load my presentation. At this point, like, I have my notecards or whatever in front of me. I am, like, shaking at this point. I am so... I don't know if it's scared or worried or maybe a combination. everything and I'm just like sweating my heart is racing like I almost feel dizzy I'm just so stressed out about what's gonna happen and then you know I'm starting to speak and then the presentations are usually like 20 minutes or so okay so I have to stay up there for the duration and I'm just like you know, sweating and I'm wondering, like, are people looking at me? Can people see it? You know, am I going to forget something?","Therapist: ""All right. So you, you survived one of the more stressful.""
Patient: ""Yeah. I almost felt like I was going to be ill. I was so stressed that day.""
Therapist: ""That was very, very tough on you. Yeah. That particular day. You did survive it. Yeah. Which is very unpleasant. Yeah. Alright. So, now we're right about to where it's time to get up and present. Right, so let's say in this scenario, you haven't fled, but you had those thoughts. Yeah. Right, so you're anxious and you have some physical symptoms going on. You get up and it's time to present. What's the sequence from this point on?""",440.13,494.89
040_053,040,53,2,"Right, or they think I'm lazy and I didn't prepare. Are they going to think that, you know, I'm dumb or I don't know, you know, what I'm doing? What are they going to think about me?","Therapist: ""So the thoughts are, I wonder if they can see how anxious I am.""
Patient: ""Yes.""
Therapist: ""I wonder if I'm going to do poorly on the presentation.""",504.92,515.58
040_059,040,59,4,"Um, it depends. Sometimes I settle down a little bit, but then usually, like, that, I, I, I get some sort of rhythm, I think, and then, but then it gets anxiety again until I get my grades. Do you know what I mean? And I'm, like, until, because I feel like I'm going to do poorly until that happens.","Therapist: ""Okay.""
Patient: ""Yeah.""
Therapist: ""So there's a number of concerns that kind of go into your mind in that moment. So when does it start to turn around? So you start presenting, it's 20 minutes. You initially get up there and get your presentation up on the projection monitor, something like that. Yeah. When does it start to turn the corner?""",545.03,566.69
040_061,040,61,2,"Sometimes, like, she usually doesn't give them that day, but, like, often, like, the next day or the day","Therapist: ""So there's a number of concerns that kind of go into your mind in that moment. So when does it start to turn around? So you start presenting, it's 20 minutes. You initially get up there and get your presentation up on the projection monitor, something like that. Yeah. When does it start to turn the corner?""
Patient: ""Um, it depends. Sometimes I settle down a little bit, but then usually, like, that, I, I, I get some sort of rhythm, I think, and then, but then it gets anxiety again until I get my grades. Do you know what I mean? And I'm, like, until, because I feel like I'm going to do poorly until that happens.""
Therapist: ""When, when do you receive the grades?""",569.15,574.74
040_063,040,63,1,"No, it definitely dissipates once I can go sit down.","Therapist: ""When, when do you receive the grades?""
Patient: ""Sometimes, like, she usually doesn't give them that day, but, like, often, like, the next day or the day""
Therapist: ""So does that intense anxiety that you're having while you're presenting last all the way?""",580.13,584.19
040_065,040,65,1,"Yeah, when eyes are maybe no longer on me, they've moved on to somebody else, so I figure, like, okay, they forgot about me, I'm safe for right then.","Therapist: ""So does that intense anxiety that you're having while you're presenting last all the way?""
Patient: ""No, it definitely dissipates once I can go sit down.""
Therapist: ""Okay, so the next big drop-off for symptoms would be when you're done with the presentation.""",591.28,599.39
040_067,040,67,2,Right. And I convinced myself that I did poorly.,"Therapist: ""Okay, so the next big drop-off for symptoms would be when you're done with the presentation.""
Patient: ""Yeah, when eyes are maybe no longer on me, they've moved on to somebody else, so I figure, like, okay, they forgot about me, I'm safe for right then.""
Therapist: ""But then there's this other worry of, Now we have to see what the grade's going to be.""",603.6,606.2
040_069,040,69,2,"Yeah. And that everyone saw me, you know, sweating and all these symptoms that I have. Everyone is judging me.","Therapist: ""But then there's this other worry of, Now we have to see what the grade's going to be.""
Patient: ""Right. And I convinced myself that I did poorly.""
Therapist: ""So the thought that's going through your mind is, I'm going to receive a bad grade.""",613.7,621.6
041_001,041,1,4,"Um, I would say maybe, like, judging.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. All right, so let's, if we could, let's rank those two things, right? So one is everyone's judging me. They saw how I was. Yeah. And the other is a poor grade. Which one is a larger fear for you?""",46.64,49.81
041_003,041,3,2,"Yeah, but I figure I could do better on the subsequent one, but when people have this opinion of you, I feel like that doesn't go away as quickly.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. All right, so let's, if we could, let's rank those two things, right? So one is everyone's judging me. They saw how I was. Yeah. And the other is a poor grade. Which one is a larger fear for you?""
Patient: ""Um, I would say maybe, like, judging.""
Therapist: ""Okay, so the grades are concerned.""",52.55,59.32
041_005,041,5,2,"Um, I guess I worry that that they would think I'm anxious because I don't know what I'm doing or I don't belong there.","Therapist: ""Okay, so the grades are concerned.""
Patient: ""Yeah, but I figure I could do better on the subsequent one, but when people have this opinion of you, I feel like that doesn't go away as quickly.""
Therapist: ""Alright, um, and what would it mean if they thought you were anxious during that presentation?""",71.4,78.61
041_009,041,9,2,"Yeah, like I don't deserve to be in that program.","Therapist: ""Okay, I don't belong there.""
Patient: ""Yeah.""
Therapist: ""So if they notice your anxiety, then they think you don't belong at that level.""",89.65,91.99
041_011,041,11,4,"Right, like maybe they think that's why I'm anxious or that's why I'm not doing well.","Therapist: ""So if they notice your anxiety, then they think you don't belong at that level.""
Patient: ""Yeah, like I don't deserve to be in that program.""
Therapist: ""I don't deserve to be in that program. Yeah. Okay. If they don't recognize those symptoms, they wouldn't think that, but if they do,""",100.61,105.17
041_013,041,13,2,"I think, you know, typically I'm one of the top students in my program and I seem to get the concepts pretty well. It's just when I have to demonstrate those concepts or demonstrate via like a presentation or something, that I'm worried that, you know, maybe I'm an imposter or something. But, um, so I start to question myself. But I think in general that, you know, I'm a pretty good student before this. Um, and I'm doing pretty well in the program.","Therapist: ""I don't deserve to be in that program. Yeah. Okay. If they don't recognize those symptoms, they wouldn't think that, but if they do,""
Patient: ""Right, like maybe they think that's why I'm anxious or that's why I'm not doing well.""
Therapist: ""Well, how do you feel about your abilities and status in the program you're in?""",114.72,148.09
041_023,041,23,2,"Um... I don't know, maybe I am. Maybe I don't deserve to be there.","Therapist: ""So if they thought you were an imposter, let's just say that that was something they actually believed because of what's been happening.""
Patient: ""Yeah.""
Therapist: ""What would that mean? What would it mean to you if your classmates thought you were an imposter?""",192.97,198.91
041_025,041,25,4,"Yeah, like maybe I shouldn't be in this program, like maybe I should just drop out.","Therapist: ""What would that mean? What would it mean to you if your classmates thought you were an imposter?""
Patient: ""Um... I don't know, maybe I am. Maybe I don't deserve to be there.""
Therapist: ""I don't deserve to be there.""",204.3,208.97
041_031,041,31,4,"Yeah. I feel like I've worked really hard, you know, to get through, you know, at least halfway through my program. And it really hurts to think that that would be true.","Therapist: ""What's it feel like to say that?""
Patient: ""Depressing.""
Therapist: ""Yeah?""",234.55,247.62
041_035,041,35,3,Yeah.,"Therapist: ""To think this whole time you've really been, you've been faking it. You don't really belong there.""
Patient: ""Yeah.""
Therapist: ""So, I'd like to move a little bit into evaluating evidence, if that's okay. So in cognitive therapy we like to look at what's, you know, what we're feeling and what we're thinking and what's, what we can see, what's observable around us and, you know, that becomes evidence and then we, we analyze it, we evaluate it. Okay. You're worried, at some level, uh, you're worried that you don't deserve to be where you are right now.""",295.99,298.31
041_039,041,39,2,"Now that I'm thinking about it here, I mean, there's not a ton to support it.","Therapist: ""That you're not good enough to be a student in this program.""
Patient: ""Yeah.""
Therapist: ""in the program you're in, what evidence supports that belief that you're not good enough?""",318.81,323.6
041_041,041,41,2,"But in, on that day, I can think of all sorts of, you know, things to tell myself.","Therapist: ""in the program you're in, what evidence supports that belief that you're not good enough?""
Patient: ""Now that I'm thinking about it here, I mean, there's not a ton to support it.""
Therapist: ""Okay.""",324.42,330.77
041_043,041,43,2,"So maybe, like, I'm not because I'm not prepared or because I'm messing up on on the presentation that I'm gonna get a bad grade and you know if I can't If I can't speak in front of people how am I gonna speak in front of kids as a teacher?","Therapist: ""Okay.""
Patient: ""But in, on that day, I can think of all sorts of, you know, things to tell myself.""
Therapist: ""All right, let's, let's go there then, on that day.""",333.49,351.13
042_001,042,1,2,"Besides my bad grade that I got that one time, yeah. Not a whole lot.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Any other evidence that points toward you being an imposter?""",32.17,39.08
042_003,042,3,1,"I would say that, you know, I was accepted into the program. Like, there's kind of, like, a pretty rigorous sort of testing and stuff, which I passed, to get in interviews and such to get into the program. So I did that. Like I said, I'm a pretty good student, all considering, you know, before this kind of, like, was happening.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Any other evidence that points toward you being an imposter?""
Patient: ""Besides my bad grade that I got that one time, yeah. Not a whole lot.""
Therapist: ""All right. So to be safe to say that a lot of that I'm not good enough. It's kind of based on this on these feelings of anxiety Yeah, which are really intense like panic almost in the moment Yes, so in a way you're Believing what the anxiety would lead you to believe. Yeah, definitely but in the bright light of scrutiny There are a lot of facts to support The worst case which is you don't deserve it, right? Right. How about evidence that refutes that you're not good enough?""",81.28,105.38
042_005,042,5,1,"I mean, now that you're kind of like talking about it like a, you know, this or that sort of thing, it makes sense I would probably say that, well, you seem to be doing pretty well so far, you know, that anyone evaluating would look at all of cumulative how you're doing your performance rather than that of weight.","Therapist: ""All right. So to be safe to say that a lot of that I'm not good enough. It's kind of based on this on these feelings of anxiety Yeah, which are really intense like panic almost in the moment Yes, so in a way you're Believing what the anxiety would lead you to believe. Yeah, definitely but in the bright light of scrutiny There are a lot of facts to support The worst case which is you don't deserve it, right? Right. How about evidence that refutes that you're not good enough?""
Patient: ""I would say that, you know, I was accepted into the program. Like, there's kind of, like, a pretty rigorous sort of testing and stuff, which I passed, to get in interviews and such to get into the program. So I did that. Like I said, I'm a pretty good student, all considering, you know, before this kind of, like, was happening.""
Therapist: ""Okay. So, you got through a rigorous process to become a student. You're doing well. Yeah. You mentioned before just the one bad grade, right? Um, okay. So, if, you know, you have friends in this program, right? Yeah. If one of them came to you with this, this balance, of, you know, one bad grade and some anxiety versus passing, you know, rigorous standards and doing well otherwise. What advice would you give them?""",141.46,169.37
042_007,042,7,4,"I think I try to sometimes but my anxiety symptoms kind of like really like you were saying your anxiety tells you sort of I think I can think that, but I think my anxiety symptoms are such in the moment that it's really hard. You know, and I'm replaying what happened before in my head, anticipation, predicting that it'll happen again.","Therapist: ""Okay. So, you got through a rigorous process to become a student. You're doing well. Yeah. You mentioned before just the one bad grade, right? Um, okay. So, if, you know, you have friends in this program, right? Yeah. If one of them came to you with this, this balance, of, you know, one bad grade and some anxiety versus passing, you know, rigorous standards and doing well otherwise. What advice would you give them?""
Patient: ""I mean, now that you're kind of like talking about it like a, you know, this or that sort of thing, it makes sense I would probably say that, well, you seem to be doing pretty well so far, you know, that anyone evaluating would look at all of cumulative how you're doing your performance rather than that of weight.""
Therapist: ""Would you feel comfortable giving that advice to yourself?""",175.64,200.42
042_009,042,9,1,"I would say like, you know, a two or a three. Like not very, I don't believe it very much right now because, you know, I'm not presenting and it's just you and I, not like a group full of people. So that's That pressure is not there here.","Therapist: ""Would you feel comfortable giving that advice to yourself?""
Patient: ""I think I try to sometimes but my anxiety symptoms kind of like really like you were saying your anxiety tells you sort of I think I can think that, but I think my anxiety symptoms are such in the moment that it's really hard. You know, and I'm replaying what happened before in my head, anticipation, predicting that it'll happen again.""
Therapist: ""All right. So let's look at the thought and the feeling. If you had to rate the percent that you believed, this thought, this belief that you are not good enough to be in the program. Like right now. Right now. Yeah, here with me. How much of your mind believes that that's true?""",233.57,248.79
042_013,042,13,4,"I want to feel really confident in that moment. It feels very real, like any moment they're going to kick me out. Like I'm just not doing well.","Therapist: ""So right now, you're really not buying the idea that you're not good enough.""
Patient: ""Yeah, correct.""
Therapist: ""To be in the program. So now let's move to, let's say, right near the end of a presentation when that anxiety is there and the classmates, they could be looking at you, they could be negatively evaluating you. Yeah. That's what you're worried about. How much do you believe that thought then?""",281.22,290.7
042_017,042,17,1,"Definitely now. Now when that anxiety and that, you know, heart rate and sweating is not there.","Therapist: ""It's that bad?""
Patient: ""Yeah.""
Therapist: ""Yeah, really intense. So would you think that you were a more accurate evaluator of what's true or not? Now or when you're in that state of anxiety?""",307.79,314.16
042_021,042,21,1,Would say you know when I'm not at risk of presenting like I feel like I spend the majority of my time Like it's not something. I worry about all the time.,"Therapist: ""So this evaluation, the percent that you believe that thought is true, this evaluation is more accurate?""
Patient: ""Yes, I think so.""
Therapist: ""And how much time in any given day would you spend kind of in a mood you're in now where you can evaluate accurately?""",335.26,344.14
042_027,042,27,2,"Yeah, exactly.","Therapist: ""However, in that moment, you still, those beliefs are strong, right?""
Patient: ""Yes. Very.""
Therapist: ""And troubling. Even though it's a small percentage, it's intense and you kind of carry that around with you a little bit.""",383.13,385.14
043_001,043,1,3,Okay.,"Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. All right, so let's, if we could, let's talk about the moment in the presentation again, right? I want to try to help you develop some strategies to bring those anxiety symptoms down.""",43.23,45.82
043_005,043,5,2,"I guess I'm like very observant, like I start looking around like I'm sweating, like I'm having physical responses and I'm looking around to see if anyone's already looking at me, like hypervigilance.","Therapist: ""Right. Let's actually go right before the moment. So you're still in the, you're still sitting down and you're getting ready to present. Let's just say you're second to present. Yeah. Like we've talked about. And you're thinking they're going to see me as anxious. They're going to think I don't belong here. These are the... Right. Okay. So these thoughts occur because you have an expectation, a rule, an attitude that you brought into that class. When you walked into that class, you have these expectations already. It's perfectly natural. It's not right or wrong. Everyone has these beliefs. And whatever these beliefs are, and we'll talk about that at another point, they combine with the stressor of having this presentation in front of you and the classmates watching you. And they result in these thoughts. We call them automatic thoughts. And just like the beliefs, they're not good or bad. They don't say anything about the person having them. They're just thoughts. Actually, they're fairly understandable and natural thoughts. The problem is that they lead to symptoms. So you're sitting there at your desk, and you're thinking, they're going to see that I'm anxious, they're going to realize I'm not good enough or think I'm not good enough.""
Patient: ""Right.""
Therapist: ""What reaction do you have when you have that thought?""",142.24,153.78
043_009,043,9,1,"And so that you know I could maybe like take some deep breaths or try to calm myself down Maybe like look over my notes one more time Because they're all watching the person who is presenting not me Okay, so some some deep breathing Looking over your notes like preparing yourself right work","Therapist: ""Okay. So distressing symptoms.""
Patient: ""Yeah.""
Therapist: ""Yeah. What's something that you could save yourself in that moment that would Maybe get in between that thought and that reaction so that thought of I'm not they're gonna know I'm not good enough or think I'm not good enough and that reaction I Mean I think in that moment most people are looking at the person who's presenting and not at me, okay""",189.34,214.67
043_011,043,11,1,I mean like usually have like index cards about or maybe like some stats on something that I want to look over like some numbers or something I don't want to forget.,"Therapist: ""Yeah. What's something that you could save yourself in that moment that would Maybe get in between that thought and that reaction so that thought of I'm not they're gonna know I'm not good enough or think I'm not good enough and that reaction I Mean I think in that moment most people are looking at the person who's presenting and not at me, okay""
Patient: ""And so that you know I could maybe like take some deep breaths or try to calm myself down Maybe like look over my notes one more time Because they're all watching the person who is presenting not me Okay, so some some deep breathing Looking over your notes like preparing yourself right work""
Therapist: ""kind of focusing on that and realizing they're not really looking at you anyway at that moment. Right. Okay. Good. Good. You bring your notes with you to class?""",228.59,238.03
043_017,043,17,4,"A little bit, but with not much success because usually when I think to remember it, I'm in, you know, panic mode, and then it's really hard.","Therapist: ""And, you know, if you're focusing on that and you're thinking about that, you're not thinking about whatever they might be thinking about.""
Patient: ""Right, exactly.""
Therapist: ""All right. And how about the deep breathing? Is that a strategy you've tried before?""",268.27,277.66
044_001,044,1,3,"Yeah, like an outline sort of thing.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Do you have on your presentation, do you have so many bullet points you want to cover?""",32.23,34.25
044_007,044,7,1,"Like a rhythm, sort of. Yeah, I could do that.","Therapist: ""I don't know how many bullet points you'd have in a presentation. Maybe you'd have 10 or 20?""
Patient: ""Something like that, yeah.""
Therapist: ""Depending on how long it is. Right. So maybe you, as you start to review a certain bullet point, as you're trying to get it into your memory and think about it, you breathe in really deeply. And then as you continue on, you just let out that breath really slowly.""",71.82,74.22
044_017,044,17,2,"Yeah, exactly. And just get really foggy, almost dizzy.","Therapist: ""Just make sure you keep your bullet points at a length of... Not a few paragraphs. Yes. But just a few seconds each so you can get a good deep breath. Or you could, you know, if you did have a longer bullet point, you could have obviously several breaths. But just some rhythm that you could kind of grab onto, something concrete.""
Patient: ""Yeah.""
Therapist: ""Because I know that in that moment things are probably, like you mentioned, zoning out. Right. It becomes very easy to lose your anchors.""",122.35,125.67
044_019,044,19,2,"The next one, I believe, is next Friday.","Therapist: ""Because I know that in that moment things are probably, like you mentioned, zoning out. Right. It becomes very easy to lose your anchors.""
Patient: ""Yeah, exactly. And just get really foggy, almost dizzy.""
Therapist: ""Yeah, so if you can remember, you know, for a particular bullet point that you want to take three deep breaths, you know, that might be something you can really grab onto. Yeah. And would kind of cut through that fogginess, so something you could still do. Okay. All right. When's the next presentation in that class that's coming up?""",150.32,154.46
044_021,044,21,1,I think I'm actually third in this one. Okay. So not first.,"Therapist: ""Yeah, so if you can remember, you know, for a particular bullet point that you want to take three deep breaths, you know, that might be something you can really grab onto. Yeah. And would kind of cut through that fogginess, so something you could still do. Okay. All right. When's the next presentation in that class that's coming up?""
Patient: ""The next one, I believe, is next Friday.""
Therapist: ""Is that the next presentation you have, like, in all the classes, is the one? Yeah. Okay. And that's next Friday. Mm-hmm. Do you know where you are in the order, like, for presenting?""",168.78,173.22
044_035,044,35,2,"I guess I could say that, you know, in general, I do pretty well. You know, one bad grade isn't going to make me doesn't mean that I don't deserve to be here.","Therapist: ""Right. Because that might help reduce that anxiety.""
Patient: ""Yeah.""
Therapist: ""What's one thing you could say to yourself when you're up there?""",229.3,243.96
044_037,044,37,2,Maybe I've prepared enough. You know that I know that I've prepared. And I'm a good student.,"Therapist: ""What's one thing you could say to yourself when you're up there?""
Patient: ""I guess I could say that, you know, in general, I do pretty well. You know, one bad grade isn't going to make me doesn't mean that I don't deserve to be here.""
Therapist: ""Okay. So the self-talk up there could be, I deserve to be here.""",250.13,255.4
044_043,044,43,1,"Yeah. Internally, as you... Because it's not long, I think I could, it would be easy to remember, and I could just, like, maybe put it down on one of my note cards in front of me or something.","Therapist: ""All right. Is that something that would be helpful to write down and have as part of your notes that you can...""
Patient: ""Yeah, I think it would actually.""
Therapist: ""You can recite that.""",272.14,281.09
044_045,044,45,2,"I think, you know, sitting now, sitting here now, I believe them. In the moment, sometimes it's a little hard to believe, because I convince myself otherwise, but","Therapist: ""You can recite that.""
Patient: ""Yeah. Internally, as you... Because it's not long, I think I could, it would be easy to remember, and I could just, like, maybe put it down on one of my note cards in front of me or something.""
Therapist: ""And how much do you believe that those statements are true?""",287.2,296.65
044_051,044,51,1,"And I think, you know, what you kind of suggested before, like maybe practicing my deep breathing, like maybe now, like when I'm calm and getting into a habit of deep breathing, like I'm more apt to also remember it then.","Therapist: ""I would like to see you right before that. So it'll be about a week. Okay. Right before that. Do you have any questions? These are items you can rehearse still, even without the presentation, the self-talk and the breathing, and of course preparing. But do you have any questions between now and then, you think?""
Patient: ""I don't think so. I think it makes sense.""
Therapist: ""You understand kind of the plan to... Yeah. attack that anxiety symptom.""",386.3,400.6
045_003,045,3,4,"It's been up and down. I think today it's probably a 7 again, but I've been back down to a 9 lately. I guess maybe I feel a little better because I'm coming here and I know and get to talk about it a little bit, but... I guess, you know, last time we were talking about me trying to get a job, a full-time job, and I think I just realized last week that it's really hard for me to work full-time. Right now, you know, I'm doing the part-time thing. with the work program and they want us to do volunteer work in the afternoon if we haven't found a full-time job by a certain week and I just, you know, just thinking about it and I just don't think I can do that. I just don't think I can work a full eight hours every day. It's just too much.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Hello, Sophia. How are you doing today?""
Patient: ""I'm good. How are you?""
Therapist: ""I'm doing well. Thanks for asking. I saw you last time a week ago, and I know you had some concerns with employment, working on employment. But first, before we get into that, I wanted to check in to see how you're doing emotionally. I know from last week, on a scale of 1 to 10, you said your depression was about 7. Yeah. How is it today?""",61.53,111.31
045_011,045,11,5,"Well, I mean, I don't really know why it is. I know I'm always tired because I just have so much trouble sleeping. As I told you before, it's just... It doesn't matter how tired I am, I can't sleep. But, it's just... I go in the morning, you know, 8 to noon, but then in the afternoon, it's just like, it's so hard to keep going on. It's just such a long amount of time, and I just feel like, I don't know if I can really do it, and especially in the winter, you know, if you work 8 hours, by the time you get out of work, it's dark out, and it just makes my depression so much worse.","Therapist: ""Does that make sense? Mm-hmm. Okay. Anything you want to add or take away from that?""
Patient: ""No, I mean, that makes sense.""
Therapist: ""Okay, great. So, tell me a little bit more about what's going on with the work.""",191.94,229.99
045_015,045,15,2,"It's hard. It's hard, but I feel like I'm better at that. I'm better at it. I'm already up anyway. So, you know, I know I got to get up. I got to do what I have to do.","Therapist: ""So the latter part of the day is more of a struggle for you.""
Patient: ""Yeah.""
Therapist: ""The latter part of the work day. Yeah. So getting up in the morning, getting to work on time, you do okay with that?""",246.0,258.12
045_021,045,21,5,"Well, yeah. Since I've been there for, what is it, eight weeks, and I haven't found a job yet, they want us to volunteer in the afternoon, and they find us our own place a volunteer so that's good I don't have to find that myself but I guess they want to get you used to doing something for eight hours a day and maybe have something to put on your resume I guess when you have like a big gap in your resume that doesn't look good either so being able to say I worked here even though I didn't make money but just thinking about it it's so exhausting and you know if I get out of the work program and I think if I had to go to I can barely make it home. It's just so all I want to do is go home Thinking about it's exhausting.","Therapist: ""What hours are you there?""
Patient: ""Eight to noon.""
Therapist: ""Eight to noon. Okay. And there's some work you have to do in the afternoon?""",272.75,324.43
045_023,045,23,4,Just don't think I can do it like I just don't think I'm the kind of person that can work eight hours a day and it just makes me feel like What's the point like I'm gonna work eight hours a day. I Don't think I can,"Therapist: ""Eight to noon. Okay. And there's some work you have to do in the afternoon?""
Patient: ""Well, yeah. Since I've been there for, what is it, eight weeks, and I haven't found a job yet, they want us to volunteer in the afternoon, and they find us our own place a volunteer so that's good I don't have to find that myself but I guess they want to get you used to doing something for eight hours a day and maybe have something to put on your resume I guess when you have like a big gap in your resume that doesn't look good either so being able to say I worked here even though I didn't make money but just thinking about it it's so exhausting and you know if I get out of the work program and I think if I had to go to I can barely make it home. It's just so all I want to do is go home Thinking about it's exhausting.""
Therapist: ""Yeah, can you tell me what type of thoughts you're having as you I?""",328.48,343.73
046_001,046,1,4,"Yeah, I can't do it. Some people can, but I can't. I'm not capable of that.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So your automatic thought, and we've touched on this before, that thought that kind of comes up right before you have a feeling that's unpleasant. I'm really not the type of person that can work eight hours.""",39.36,44.02
046_003,046,3,4,"I don't know. It just makes me feel like a loser, like I'll never really take care of myself.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So your automatic thought, and we've touched on this before, that thought that kind of comes up right before you have a feeling that's unpleasant. I'm really not the type of person that can work eight hours.""
Patient: ""Yeah, I can't do it. Some people can, but I can't. I'm not capable of that.""
Therapist: ""And what does it mean that you're not the type of person who can work eight hours?""",53.13,61.28
046_005,046,5,4,"Yeah, I think so. I mean, usually it's more like, I can't do this, or I'm not capable, but I think it really comes down to feeling like a loser.","Therapist: ""And what does it mean that you're not the type of person who can work eight hours?""
Patient: ""I don't know. It just makes me feel like a loser, like I'll never really take care of myself.""
Therapist: ""So you believe you're a loser? Yeah. Has that been a self-statement belief that you've made before, you've had before?""",76.1,87.97
046_007,046,7,4,"Yeah. I mean, I don't know what you mean by core belief.","Therapist: ""So you believe you're a loser? Yeah. Has that been a self-statement belief that you've made before, you've had before?""
Patient: ""Yeah, I think so. I mean, usually it's more like, I can't do this, or I'm not capable, but I think it really comes down to feeling like a loser.""
Therapist: ""And you feel like this, called core belief, the I'm a loser core belief, this is the reason you struggle with the work, with the eight hours?""",107.42,110.22
046_009,046,9,4,"Yeah, I mean, I guess, like, I can't do this. Like, probably also thoughts that lead to my depression, like, you know, no one's going to love me. I'm not capable of, like, functioning properly. Like, there's not really a point to anything. I guess those kinds of thoughts.","Therapist: ""And you feel like this, called core belief, the I'm a loser core belief, this is the reason you struggle with the work, with the eight hours?""
Patient: ""Yeah. I mean, I don't know what you mean by core belief.""
Therapist: ""Core belief. So, kind of... We've talked about the thoughts, and you can think of those more on the surface. These different thoughts, like I'm not the kind of person that can work eight hours. Moving kind of deeper into cognition, we have... increasingly central levels of thinking and beliefs. So, when you get to the most critical, the most foundational, those are the core beliefs. So, for example, when you say, I'm a loser, that core belief, eventually that can lead to all kinds of different thoughts. And what can tie those thoughts together is this, I'm a loser. Do you ever notice any other thoughts you think could be connected to that?""",161.89,186.4
046_011,046,11,4,I don't know. I just... I don't know. I... No. Nothing specific I can think of.,"Therapist: ""Core belief. So, kind of... We've talked about the thoughts, and you can think of those more on the surface. These different thoughts, like I'm not the kind of person that can work eight hours. Moving kind of deeper into cognition, we have... increasingly central levels of thinking and beliefs. So, when you get to the most critical, the most foundational, those are the core beliefs. So, for example, when you say, I'm a loser, that core belief, eventually that can lead to all kinds of different thoughts. And what can tie those thoughts together is this, I'm a loser. Do you ever notice any other thoughts you think could be connected to that?""
Patient: ""Yeah, I mean, I guess, like, I can't do this. Like, probably also thoughts that lead to my depression, like, you know, no one's going to love me. I'm not capable of, like, functioning properly. Like, there's not really a point to anything. I guess those kinds of thoughts.""
Therapist: ""So a lot of your thoughts and maybe your core beliefs negative and Kind of they put you down You remember when that first started like long you've been dealing with this I just feel like I've always felt this way Do you feel there was a particular cause you can remember""",219.38,226.61
046_013,046,13,4,"Yeah. And I have had trouble with jobs and stuff like that, you know? So that would make it worse. You know, stuff happens. But I can't say like, oh, this specific thing happened and then I felt this way. It's like a million little things.","Therapist: ""So a lot of your thoughts and maybe your core beliefs negative and Kind of they put you down You remember when that first started like long you've been dealing with this I just feel like I've always felt this way Do you feel there was a particular cause you can remember""
Patient: ""I don't know. I just... I don't know. I... No. Nothing specific I can think of.""
Therapist: ""Just kind of always felt this way. Nothing really... specific caused it. Just that feeling of being down. Thoughts that you're really not... You're not going to be successful.""",241.47,261.76
046_015,046,15,4,"Well, it's been hard. I mean, my boyfriend now, he puts a lot of pressure on me. He wants me to get a job. And I just, like, I don't know if I really can. And, you know, I've had a lot of relationships not work out. It's been hard. It's hard. You know, and sometimes I feel like I'm not going to be able to take care of myself. And then I feel like, you know, if my relationship doesn't work out and I can't take care of myself, what's going to happen to me? And it's really, it's just really overwhelming.","Therapist: ""Just kind of always felt this way. Nothing really... specific caused it. Just that feeling of being down. Thoughts that you're really not... You're not going to be successful.""
Patient: ""Yeah. And I have had trouble with jobs and stuff like that, you know? So that would make it worse. You know, stuff happens. But I can't say like, oh, this specific thing happened and then I felt this way. It's like a million little things.""
Therapist: ""Little things. How have you done with relationships?""",273.17,304.45
046_017,046,17,2,"I am dependent on him. I mean, right now, I do not have enough money to take care of myself, and my family is not the kind of people that can help me, so I don't know what I would do. I dunno.","Therapist: ""Little things. How have you done with relationships?""
Patient: ""Well, it's been hard. I mean, my boyfriend now, he puts a lot of pressure on me. He wants me to get a job. And I just, like, I don't know if I really can. And, you know, I've had a lot of relationships not work out. It's been hard. It's hard. You know, and sometimes I feel like I'm not going to be able to take care of myself. And then I feel like, you know, if my relationship doesn't work out and I can't take care of myself, what's going to happen to me? And it's really, it's just really overwhelming.""
Therapist: ""So this is a stressor for you, too. Because you kind of think about, specifically the relationship with your boyfriend you're referring to, that you're kind of dependent to some degree, or you're worried you might be dependent.""",319.35,339.31
047_001,047,1,3,"Yeah, I could probably afford a place on my own if I had to.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. And this ties into the employment, right? So if you're working full-time, you'd be more independent.""",36.25,39.44
047_005,047,5,5,"Yeah, I was. I had a job. It just... I think it was the same thing. Like, it was just so hard for me to function. I think with the not sleeping and everything by the time... afternoon comes around, I just can't even think. And like I said, I would get home, I would leave work at five and I would just be so depressed. I would just go home and lay in bed because, you know, it's like the day's over. I can't do anything. You know, I, I like to go for walks and I think that helps me and can't do that because it's dark out already. And it just feels like, You know, if this is what I have to do day to day to just get by, I don't know. I don't think I can do that. And it didn't last very long. I couldn't do it. I don't know what's going to be different this time.","Therapist: ""But then we look at that. Working a full eight hours a day is just tough on you.""
Patient: ""Yeah, I don't think it's possible.""
Therapist: ""You were employed before this program, like some time ago, right?""",56.07,114.95
047_007,047,7,4,"I called out sick too many times. I was fine in the morning, but I knew I couldn't make it through the whole day. And I have been drinking sometimes too, so I call out on Mondays when I drink too much on the weekend. You can only call out so many times from work that they'll let you stay there.","Therapist: ""You were employed before this program, like some time ago, right?""
Patient: ""Yeah, I was. I had a job. It just... I think it was the same thing. Like, it was just so hard for me to function. I think with the not sleeping and everything by the time... afternoon comes around, I just can't even think. And like I said, I would get home, I would leave work at five and I would just be so depressed. I would just go home and lay in bed because, you know, it's like the day's over. I can't do anything. You know, I, I like to go for walks and I think that helps me and can't do that because it's dark out already. And it just feels like, You know, if this is what I have to do day to day to just get by, I don't know. I don't think I can do that. And it didn't last very long. I couldn't do it. I don't know what's going to be different this time.""
Therapist: ""What eventually brought an end to that job?""",120.86,143.09
047_009,047,9,4,"It was worse, because I feel like I realized I really can't hold a full-time job, and, you know, my boyfriend is coming down on me hard, like, you need to go get a job, I can't pay for everything, and... Yeah, it was worse. It was worse. I felt like more of a loser, I guess. Like you said, that's like a core belief, I just felt worse, more like a loser.","Therapist: ""What eventually brought an end to that job?""
Patient: ""I called out sick too many times. I was fine in the morning, but I knew I couldn't make it through the whole day. And I have been drinking sometimes too, so I call out on Mondays when I drink too much on the weekend. You can only call out so many times from work that they'll let you stay there.""
Therapist: ""So eventually you lost that job. So moving from that job to not working, how did your depression change, if at all?""",160.38,188.83
047_011,047,11,2,"I felt better when I first started. I did, like, I guess maybe getting out of the house and, you know, having to do something, it helps a little bit with my sleep. So, you know, it gave me a little bit of hope.","Therapist: ""So eventually you lost that job. So moving from that job to not working, how did your depression change, if at all?""
Patient: ""It was worse, because I feel like I realized I really can't hold a full-time job, and, you know, my boyfriend is coming down on me hard, like, you need to go get a job, I can't pay for everything, and... Yeah, it was worse. It was worse. I felt like more of a loser, I guess. Like you said, that's like a core belief, I just felt worse, more like a loser.""
Therapist: ""How about when you started the work program recently?""",195.73,211.55
047_013,047,13,4,"Yeah, yeah. But now I kind of feel like it's pointless because I'm not going to be able to work full-time and you can't just do a work program for the rest of your life. So, yeah, I don't know.","Therapist: ""How about when you started the work program recently?""
Patient: ""I felt better when I first started. I did, like, I guess maybe getting out of the house and, you know, having to do something, it helps a little bit with my sleep. So, you know, it gave me a little bit of hope.""
Therapist: ""So the work program was a positive thing? element in your life.""",220.26,232.33
047_017,047,17,4,"Yeah. But it's worse, I think, because I just feel like I'm never going to be able to do the things that other people want me to do or that I need to do to be successful, to function.","Therapist: ""So it's positive, but in a way it's leading back to what you didn't succeed at before, the full-time work.""
Patient: ""Yeah.""
Therapist: ""So that same depression, you're feeling something like that that you had before.""",249.13,264.14
047_019,047,19,5,"Yeah. I just feel like I'm in this spiral where I can't... keep it together, I can't hold a job, so my boyfriend hates me, so he breaks up with me, and then I can't fend for myself, so I have to go get a job, but then, you know, I can't keep that.","Therapist: ""So that same depression, you're feeling something like that that you had before.""
Patient: ""Yeah. But it's worse, I think, because I just feel like I'm never going to be able to do the things that other people want me to do or that I need to do to be successful, to function.""
Therapist: ""Hmm. You're never going to be able to do what you need to do.""",275.17,290.45
047_021,047,21,4,"Yeah, and I don't really think it's possible for me to keep the job. You know, I can get the job. I can work there for a while, but it's not possible to keep it. I'm just not cut out for it.","Therapist: ""Hmm. You're never going to be able to do what you need to do.""
Patient: ""Yeah. I just feel like I'm in this spiral where I can't... keep it together, I can't hold a job, so my boyfriend hates me, so he breaks up with me, and then I can't fend for myself, so I have to go get a job, but then, you know, I can't keep that.""
Therapist: ""That's depressing, thinking about that eight-hour day. So, on one hand, if you were able to keep the job, you'd be down, because you have the job. On the other hand, you're down because you don't.""",309.53,322.11
047_023,047,23,2,"Yeah, not so much that it's not an option. It's just like they won't want to keep me, if that makes any sense.","Therapist: ""That's depressing, thinking about that eight-hour day. So, on one hand, if you were able to keep the job, you'd be down, because you have the job. On the other hand, you're down because you don't.""
Patient: ""Yeah, and I don't really think it's possible for me to keep the job. You know, I can get the job. I can work there for a while, but it's not possible to keep it. I'm just not cut out for it.""
Therapist: ""So keeping is really not an option in your mind, the way you're thinking now?""",328.36,336.11
047_027,047,27,2,"Like, I want to have a job. I want to have a full-time job. But I don't want to work eight hours. So, I guess that's where it's difficult. You know what I mean? Like, I want to have a full-time job so I can take care of myself and pay for things. But I don't want to work eight hours. I know that sounds crazy, but it's just like, I don't think I can.","Therapist: ""Okay, so you'll want to stay.""
Patient: ""Kind of, yeah.""
Therapist: ""And you can... Kind of. I mean, you're somewhat motivated to stay.""",341.97,361.87
047_029,047,29,5,"Yeah, I'll do things, like I'll leave early because I can't handle it, or it won't come in, and then they'll just be like, well, we can't have an employee who doesn't show up. I need the money, but I can't function well enough to keep the job. It's just not in me.","Therapist: ""And you can... Kind of. I mean, you're somewhat motivated to stay.""
Patient: ""Like, I want to have a job. I want to have a full-time job. But I don't want to work eight hours. So, I guess that's where it's difficult. You know what I mean? Like, I want to have a full-time job so I can take care of myself and pay for things. But I don't want to work eight hours. I know that sounds crazy, but it's just like, I don't think I can.""
Therapist: ""You don't think you can. And they'll pick up on that. And...""",366.58,385.8
048_001,048,1,4,"first that'll get you in trouble that will jeopardize that full-time job i guess like calling out or leaving early is that that's the big one yeah okay what else probably my drinking is not helpful tell me about that i just you know like sometimes i just get so depressed in the afternoon they start drinking and then it makes it hard for me to get to work the next day like I can't get another DUI. If I drive in the morning, sometimes I'm still drunk or I oversleep and it doesn't help, but it, yeah.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Let's try to make a list of what will get in the way of employment in terms of the employer's reaction. Let's assume you continue with the work program and you get a full-time job. You're motivated to work it, but you're worried they're going to eventually let you go, because of the depression. And so, therefore, you're really not capable of keeping it. Kind of going from, well, any order, but if you can, from the things they'll notice first. What behaviors from you will they notice""",70.76,111.78
048_003,048,3,5,"Yeah. Yeah. And another thing is just my sleep. With my sleep being so bad for my depression, like, I'm at risk for oversleeping because even if I'm not drinking, like, I can't sleep, I finally fall asleep, and then I just sleep so hard because I've been awake for like 30 hours that I sleep through my alarms, no matter how loud they are, and then wake up an hour late, and then you can't just tell people every week that you overslept, you know? Yeah, people oversleep, but when you call in every week and say, I'm sorry, I overslept, I don't care. Or I'll be tired all day, and I make mistakes, and I just can't function. Partway through the day, I just can't keep doing it.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Let's try to make a list of what will get in the way of employment in terms of the employer's reaction. Let's assume you continue with the work program and you get a full-time job. You're motivated to work it, but you're worried they're going to eventually let you go, because of the depression. And so, therefore, you're really not capable of keeping it. Kind of going from, well, any order, but if you can, from the things they'll notice first. What behaviors from you will they notice""
Patient: ""first that'll get you in trouble that will jeopardize that full-time job i guess like calling out or leaving early is that that's the big one yeah okay what else probably my drinking is not helpful tell me about that i just you know like sometimes i just get so depressed in the afternoon they start drinking and then it makes it hard for me to get to work the next day like I can't get another DUI. If I drive in the morning, sometimes I'm still drunk or I oversleep and it doesn't help, but it, yeah.""
Therapist: ""So the drinking could be contributing to the big factor why you might lose the job, which is the lateness or leaving early. It could be contributing to the lateness.""",125.48,178.19
048_005,048,5,4,"able to completely stop i don't know i i guess i mean like you said about the being late like it might help with that and that might help me keep my job but at the same time sometimes i don't know i just feel like i can't stop because if i'm trying to hold down a job and all the depression of being there late and coming home at five and it's dark. I don't think I could get through it and go to work the next day without drinking. I just, I don't think it's possible.","Therapist: ""So the drinking could be contributing to the big factor why you might lose the job, which is the lateness or leaving early. It could be contributing to the lateness.""
Patient: ""Yeah. Yeah. And another thing is just my sleep. With my sleep being so bad for my depression, like, I'm at risk for oversleeping because even if I'm not drinking, like, I can't sleep, I finally fall asleep, and then I just sleep so hard because I've been awake for like 30 hours that I sleep through my alarms, no matter how loud they are, and then wake up an hour late, and then you can't just tell people every week that you overslept, you know? Yeah, people oversleep, but when you call in every week and say, I'm sorry, I overslept, I don't care. Or I'll be tired all day, and I make mistakes, and I just can't function. Partway through the day, I just can't keep doing it.""
Therapist: ""I'm just so tired, and I just... What would this scenario be like with work if there were no drinking in the equation, if you were...""",190.15,222.44
048_007,048,7,5,"Yeah, yeah, that's what I'm saying. So they have a, there's a relationship between the... Like, I know it's not great, and I know it's not making everything better, like, but I just, I don't know how to stop, and I don't think I need to. I think, I don't know, there's just so many things going on, and it's just not really something I'm really focused on.","Therapist: ""I'm just so tired, and I just... What would this scenario be like with work if there were no drinking in the equation, if you were...""
Patient: ""able to completely stop i don't know i i guess i mean like you said about the being late like it might help with that and that might help me keep my job but at the same time sometimes i don't know i just feel like i can't stop because if i'm trying to hold down a job and all the depression of being there late and coming home at five and it's dark. I don't think I could get through it and go to work the next day without drinking. I just, I don't think it's possible.""
Therapist: ""So, so let's look at the, let's look at the alcohol and the work. So the alcohol might lead to some of the stresses at work, right? Might cause some of the lateness and maybe other problems, but also Is the alcohol partially caused? Like, is drinking partially caused by the depression you have at work?""",245.62,269.57
048_009,048,9,2,"Probably like I mean Ideally, I would like to drink like recreationally, you know like normally and Not have to drink because I'm stressed out and not have it","Therapist: ""So, so let's look at the, let's look at the alcohol and the work. So the alcohol might lead to some of the stresses at work, right? Might cause some of the lateness and maybe other problems, but also Is the alcohol partially caused? Like, is drinking partially caused by the depression you have at work?""
Patient: ""Yeah, yeah, that's what I'm saying. So they have a, there's a relationship between the... Like, I know it's not great, and I know it's not making everything better, like, but I just, I don't know how to stop, and I don't think I need to. I think, I don't know, there's just so many things going on, and it's just not really something I'm really focused on.""
Therapist: ""Stopping drinking If there were another Method strategy to deal with the depression that worked would it be easier to stop the drinking then?""",284.76,298.49
048_011,048,11,5,"I guess I would like to cut back if I could like Because I only drink the way I do because I'm so stressed out So if I felt better, I probably wouldn't drink like this, you know I might have like a drink at a party or with dinner or something like that, but I feel like I could keep it within reason if I just felt normal.","Therapist: ""Stopping drinking If there were another Method strategy to deal with the depression that worked would it be easier to stop the drinking then?""
Patient: ""Probably like I mean Ideally, I would like to drink like recreationally, you know like normally and Not have to drink because I'm stressed out and not have it""
Therapist: ""Affect me and not have all these DUIs and stuff like that So you You'd like to stop drinking, but you don't see a clear way To that right now.""",312.06,332.95
049_001,049,1,4,"I don't know. Probably not. I just feel like, you know, I need something to help me feel better, and it does. I know that it has certain negative consequences, and sometimes it does make things worse, but, like, I just, I need some kind of relief. I just need it. Like, you know, sometimes it's the only thing that can get me to sleep, and I don't know.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So is it possible if you're able to cut back on drinking that you start to feel better and then want to cut back more and then you feel a little better and there's like a cyclic pattern there?""",43.22,70.1
049_005,049,5,2,"Yeah, I mean... When I first started the work program, I felt a lot better. Probably I stopped drinking by like half. It was really good. I felt hopeful. I didn't feel great, obviously, but I just felt better. So it was easier then.","Therapist: ""So you need it, and so you need to drink some a day, but maybe not as much as you're drinking. Yeah, yeah. So by what percent do you think you need to cut back?""
Patient: ""I don't know, maybe like 30%?""
Therapist: ""Drinking 30% less. And you think that would be, that would kind of help you with this job? Yeah. Yeah. If you could get to that, reducing it by 30%. Have you been at that level before?""",102.88,126.47
049_007,049,7,4,"I think just the stress of knowing that gonna have to work full-time and I just don't think that's possible and just I Don't know like worrying about that Was it all at once or did you slowly increase Do you feel like you're going to continue increasing or have you kind of leveled off I Mean At first it was less, I think, because I knew I had to stop a little bit so I could get to work, the work program. And now I just feel hopeless about it, so I've been drinking more. And I feel like it's kind of leveled off, but at the same time, if I have to do a job, it might get worse. I don't know. I don't know.","Therapist: ""Drinking 30% less. And you think that would be, that would kind of help you with this job? Yeah. Yeah. If you could get to that, reducing it by 30%. Have you been at that level before?""
Patient: ""Yeah, I mean... When I first started the work program, I felt a lot better. Probably I stopped drinking by like half. It was really good. I felt hopeful. I didn't feel great, obviously, but I just felt better. So it was easier then.""
Therapist: ""And what do you think led to bumping it back up to where it is now?""",134.85,189.87
049_011,049,11,2,"It would be hard, because when I'm stressed out, I would feel kind of adrift, but I guess it would probably be easier to get up in the morning. Sometimes I feel sick the next day, a headache. feeling a little nauseous and stuff like that so maybe you know if I didn't do it as much it might actually help a little bit with like the feeling that I can't spend the whole day at work because like when you're you have a headache and stuff it just makes it worse and makes you feel like there's no way you can stay for eight hours so maybe that would help all right so in the short run there might be some some positives and how about in the long run I mean, in the long run, I just don't know how it could happen. Like, I always try to cut back, and it just never happens. I mean, if I could stop in the long run, maybe things would get a lot better. Like, you know, if I didn't drink so much for a long time, that would give it enough time for, like, the DUIs, like, the probation to have expired, and then I won't have to worry all the time. You know, but I don't know. I don't know if that's possible.","Therapist: ""You've cut back on drinking before in the past?""
Patient: ""Yeah.""
Therapist: ""So what do you think would be the immediate feelings and thoughts if you, say, cut back by 30% right now? Like if you just were able to do that starting today, what would be your consequences in the first couple weeks?""",222.38,301.12
049_013,049,13,2,"Probably like 2, 3. Okay.","Therapist: ""So what do you think would be the immediate feelings and thoughts if you, say, cut back by 30% right now? Like if you just were able to do that starting today, what would be your consequences in the first couple weeks?""
Patient: ""It would be hard, because when I'm stressed out, I would feel kind of adrift, but I guess it would probably be easier to get up in the morning. Sometimes I feel sick the next day, a headache. feeling a little nauseous and stuff like that so maybe you know if I didn't do it as much it might actually help a little bit with like the feeling that I can't spend the whole day at work because like when you're you have a headache and stuff it just makes it worse and makes you feel like there's no way you can stay for eight hours so maybe that would help all right so in the short run there might be some some positives and how about in the long run I mean, in the long run, I just don't know how it could happen. Like, I always try to cut back, and it just never happens. I mean, if I could stop in the long run, maybe things would get a lot better. Like, you know, if I didn't drink so much for a long time, that would give it enough time for, like, the DUIs, like, the probation to have expired, and then I won't have to worry all the time. You know, but I don't know. I don't know if that's possible.""
Therapist: ""So, if you were to go home tonight, and what time do you usually start drinking?""",312.01,314.13
049_015,049,15,5,"I need a drink. I'm feeling like... just overwhelmed by all the thoughts of not being able to work a job, not being able to get ahead, and just, I'm not going to be able to sleep, and, you know, I made it through another day, but I have to go back tomorrow, and soon I have to go full-time, and if I can't go full-time, then I can't function, and it just, it's a lot. I need a drink.","Therapist: ""So, if you were to go home tonight, and what time do you usually start drinking?""
Patient: ""Probably like 2, 3. Okay.""
Therapist: ""So you go home, and it's coming up on that time. What goes through your mind as, like, right before you drink? What are you thinking about?""",328.37,359.58
050_003,050,3,5,"Yeah, I think even more than that, it's just like the feelings. Like I just feel stressed out. I have all the thoughts, they're always there, but it's like that feeling of emotional exhaustion that makes me want to do it.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So there's, I need a drink, there's that thought, there's all these other thoughts about not being able to cope with work.""
Patient: ""Yeah.""
Therapist: ""So it kind of just, is it all at once? Like all these thoughts?""",39.3,55.07
050_005,050,5,4,"I mean, it depends. The problem is, you know, While it feels good like I just feel good and simple, you know, there's not all these thoughts and It's just okay but then it's just like it always like it always tastes like more, you know, I can't stop and then I don't feel good like, you know, either I start to have the thoughts again and it's worse and I'm crying or I get sick and I can never just stay in that good spot.","Therapist: ""So it kind of just, is it all at once? Like all these thoughts?""
Patient: ""Yeah, I think even more than that, it's just like the feelings. Like I just feel stressed out. I have all the thoughts, they're always there, but it's like that feeling of emotional exhaustion that makes me want to do it.""
Therapist: ""And how about after drinking? Like a ways after drinking, do you look back and regret that you had drank, or do you feel satisfied?""",67.5,105.58
050_011,050,11,2,"I don't know. I used to feel better when I could go for walks. And I guess now that I don't work full-time, I could, and that's good. I don't, but then I worry if I do start and then I have to work full-time, it's just going to be even worse because not only am I going to be depressed because I'm working full-time, but also not being able to go for walks because I get home and it's dark out, then I'm just going to be even worse.","Therapist: ""You have a couple different fights going on. The work stress, the alcohol, and this belief that you're not going to be able to function alone, and you're not successful. There's a lot weighing you down.""
Patient: ""Yeah.""
Therapist: ""What do you think you can do to turn this around? I mean, you mentioned cutting back the drinking. Anything else?""",147.49,175.85
050_015,050,15,2,"I think just logistics. I was thinking, I don't live in a neighborhood where you can just go out and walk in the dark. You just don't do that. But I never really thought about going on my lunch break. That could be an option if I get a job where you can kind of walk around and stuff like that. That might be good.","Therapist: ""So, going for a walk, that was a strategy that did work for you.""
Patient: ""Yeah.""
Therapist: ""But you don't see how it's possible. With a full-time work schedule to return to that. So is there anything else that prevents you from walking? For example, if you have a job, maybe you can walk at lunch around where you work. Is there something else that's stopping you, or is it just the logistics of finding time?""",204.62,221.8
051_001,051,1,4,"I don't know. I would just probably be like, well, you have to do it. Like, you just have to.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. If someone told you that, like a friend of yours told you, that they just could not work eight hours a day, what would you tell them? What advice would you give them?""",43.28,51.44
051_003,051,3,1,"Yeah, probably. I think most people can.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. If someone told you that, like a friend of yours told you, that they just could not work eight hours a day, what would you tell them? What advice would you give them?""
Patient: ""I don't know. I would just probably be like, well, you have to do it. Like, you just have to.""
Therapist: ""Would you believe they could do it?""",55.32,58.87
051_005,051,5,2,"Yeah. I think that's part of what's so hard about it is it just makes me feel like I'm not normal. A normal person can work, but I can't.","Therapist: ""Would you believe they could do it?""
Patient: ""Yeah, probably. I think most people can.""
Therapist: ""Most people can. You don't really feel you can.""",64.64,75.8
051_011,051,11,2,"Probably like, how can you afford all that alcohol if you're not going to go out there and work?","Therapist: ""So you could do things like that without worry. But you've tried the full-time work and it didn't...""
Patient: ""It didn't go well.""
Therapist: ""It didn't go well. And part of that's the drinking. So you have all this tied together. So if someone came to you, And they said they couldn't work eight hours a day and they were drinking. What might you say to them?""",110.31,114.35
051_013,051,13,2,"Maybe they would have to cut back, but I know that's easier said than done.","Therapist: ""It didn't go well. And part of that's the drinking. So you have all this tied together. So if someone came to you, And they said they couldn't work eight hours a day and they were drinking. What might you say to them?""
Patient: ""Probably like, how can you afford all that alcohol if you're not going to go out there and work?""
Therapist: ""So the financial considerations certainly, yeah.""",118.54,122.62
051_021,051,21,2,"Yeah, yeah.","Therapist: ""So in that moment, let's go to the moment when you start drinking. We talked about when you're like two or three in the afternoon and your thought is, I need a drink. And you also had other thoughts about coping with working. Is there anything you could tell yourself or have told yourself in the past in that moment that might delay or prevent you from drinking?""
Patient: ""Maybe like""
Therapist: ""No, I can't I can't think of anything Has anything ever happened when you were home and about to drink that that derailed that plan It does but most of the time do you go ahead and drink yeah, yeah When you were Working full-time before, you would start drinking after work, later?""",230.31,232.38
051_023,051,23,2,"Yeah, I mean, partially it was better because, you know, I knew I had to get to bed for work, and so I couldn't drink as long, and sometimes having a bedtime, it cuts you off at a certain point. But also it was harder because, you know, if I drank too much, it was harder to recoup and go through the day and stuff like that.","Therapist: ""No, I can't I can't think of anything Has anything ever happened when you were home and about to drink that that derailed that plan It does but most of the time do you go ahead and drink yeah, yeah When you were Working full-time before, you would start drinking after work, later?""
Patient: ""Yeah, yeah.""
Therapist: ""Did that give you a different experience than starting drinking at two or three?""",237.26,263.42
051_027,051,27,2,"I mean, maybe. I know, you know, my boyfriend drinks, too, and he likes to have it in the house, but I know he really wants me to get a job, so I think that he would probably be, like, supportive in that, you know. Maybe only bringing home what he's going to drink, something like that. I think you can buy just, like, one can or something.","Therapist: ""All right. Well, let's look at the physical setup at home. You mentioned you have a boyfriend. Does anybody else live?""
Patient: ""No. No.""
Therapist: ""Do you think it would be possible to set up an environment where there's no alcohol available?""",287.28,306.02
051_029,051,29,4,"Probably. I mean... I mean, like you said, it's going to be painful.","Therapist: ""Do you think it would be possible to set up an environment where there's no alcohol available?""
Patient: ""I mean, maybe. I know, you know, my boyfriend drinks, too, and he likes to have it in the house, but I know he really wants me to get a job, so I think that he would probably be, like, supportive in that, you know. Maybe only bringing home what he's going to drink, something like that. I think you can buy just, like, one can or something.""
Therapist: ""You could reduce the amount that's available that you could get a hold of. Would that""",324.33,332.36
051_033,051,33,1,Or have my boyfriend go get some more. Or have him bring some home on his way home from work.,"Therapist: ""Be painful. Has there ever been a time when you went home and you wanted a drink or you started drinking and ran out? What happened then?""
Patient: ""I'd usually go get some more.""
Therapist: ""You'd go get some more?""",348.44,352.62
052_004,052,4,2,"Yeah. And I think it might be easier because, you know, with not having it in the house, I'll know it's because I'm not supposed to have it, but I'm not really sure how I can make a situation where I can't get alcohol, you know?","Therapist: ""All right, so it would be setting up an environment that had limited or no alcohol and then setting up a plan to deal with going out and getting more.""
Patient: ""Yeah.""
Therapist: ""That would be the temptation when you saw there's no alcohol.""",49.13,67.56
052_006,052,6,2,I can't call all the liquor stores and tell them not to sell to me or something like that. I don't really know what. What to do about that?,"Therapist: ""That would be the temptation when you saw there's no alcohol.""
Patient: ""Yeah. And I think it might be easier because, you know, with not having it in the house, I'll know it's because I'm not supposed to have it, but I'm not really sure how I can make a situation where I can't get alcohol, you know?""
Therapist: ""That might be difficult.""",68.68,74.62
052_008,052,8,4,"Probably like, I don't know what to do. Like, I want a drink. No, I shouldn't. Just starting to feel like really anxious and kind of like freaked out I guess Okay, I want a drink.","Therapist: ""That might be difficult.""
Patient: ""I can't call all the liquor stores and tell them not to sell to me or something like that. I don't really know what. What to do about that?""
Therapist: ""Well, yeah, there's only so many physical methods to prevent you getting the alcohol, right? I mean, if you really want it, you can go get it. So it comes down to dealing with the thoughts that are coming up at that moment. So let's kind of look at a situation where there's no more alcohol in the house. So let's say there's none there now. And you go home, and you have that first thought about wanting to drink. And that's, I need a drink, and the thoughts about work. You go and see there's no alcohol. What are you thinking then?""",128.93,141.59
052_010,052,10,2,Know I might go get some alcohol and like maybe like talk to my boyfriend about it.,"Therapist: ""Well, yeah, there's only so many physical methods to prevent you getting the alcohol, right? I mean, if you really want it, you can go get it. So it comes down to dealing with the thoughts that are coming up at that moment. So let's kind of look at a situation where there's no more alcohol in the house. So let's say there's none there now. And you go home, and you have that first thought about wanting to drink. And that's, I need a drink, and the thoughts about work. You go and see there's no alcohol. What are you thinking then?""
Patient: ""Probably like, I don't know what to do. Like, I want a drink. No, I shouldn't. Just starting to feel like really anxious and kind of like freaked out I guess Okay, I want a drink.""
Therapist: ""I know I shouldn't and then all these feelings of anxiety coming up and Really like severe anxiety as you contemplate not having anything drink and then what do you do so those are your thoughts and your feelings and""",160.57,166.16
052_012,052,12,2,"Yeah, yeah. It's like the things I say to myself in my head.","Therapist: ""I know I shouldn't and then all these feelings of anxiety coming up and Really like severe anxiety as you contemplate not having anything drink and then what do you do so those are your thoughts and your feelings and""
Patient: ""Know I might go get some alcohol and like maybe like talk to my boyfriend about it.""
Therapist: ""I guess or I could call my friend Okay, so you could reach out to support That might help talk to your boyfriend that might help We talked about before this idea that when an automatic thought comes up like one related in this example to one-sided anxiety about not having alcohol available. This idea of self-talk. Do you remember that from before?""",197.22,201.37
052_014,052,14,3,alcohol isn't going to change things even you know when you wake up tomorrow you're going to feel the same way and you know it's going to make you sick and you have to you know get it together and this isn't going to do that for you all right do you think if that's something you could repeat back to yourself that would help you,"Therapist: ""I guess or I could call my friend Okay, so you could reach out to support That might help talk to your boyfriend that might help We talked about before this idea that when an automatic thought comes up like one related in this example to one-sided anxiety about not having alcohol available. This idea of self-talk. Do you remember that from before?""
Patient: ""Yeah, yeah. It's like the things I say to myself in my head.""
Therapist: ""Yeah, you can say them out loud, you can think them, and they're designed to contradict and override the automatic thoughts. Those are the ones that just come up automatically, you don't directly control. So, you see there's no alcohol. You have the feeling of anxiety. You start thinking about, well, maybe about finding support, but also maybe about how to get some. What can you do at that moment? What can you say to yourself? Something we could write down in advance that you could read.""",244.17,273.24
052_016,052,16,2,"Yeah. Yeah, I mean, maybe. It's hard to tell what's going to happen until I try it, but... It could help.","Therapist: ""Yeah, you can say them out loud, you can think them, and they're designed to contradict and override the automatic thoughts. Those are the ones that just come up automatically, you don't directly control. So, you see there's no alcohol. You have the feeling of anxiety. You start thinking about, well, maybe about finding support, but also maybe about how to get some. What can you do at that moment? What can you say to yourself? Something we could write down in advance that you could read.""
Patient: ""alcohol isn't going to change things even you know when you wake up tomorrow you're going to feel the same way and you know it's going to make you sick and you have to you know get it together and this isn't going to do that for you all right do you think if that's something you could repeat back to yourself that would help you""
Therapist: ""Or reduce the risk of you going out and getting alcohol?""",277.2,283.93
052_018,052,18,4,"Yeah. I mean, I think it's going to be really hard, but... I'll try it. I just... I need... Something has to give, so... I'll try it.","Therapist: ""Or reduce the risk of you going out and getting alcohol?""
Patient: ""Yeah. Yeah, I mean, maybe. It's hard to tell what's going to happen until I try it, but... It could help.""
Therapist: ""Is that something you're willing to try?""",289.92,301.38
053_001,053,1,4,"I don't know, I was just about to ask you, like, how do I, like, you know, when I'm here, I feel like I want to do it, like I want to, like, get the alcohol out of the house and stuff, but then when I get home, I'm like, You know, if I tell my boyfriend we had to get the alcohol out of the house, then if I tell him later that I want it, then he's going to, you know, tell me, well, you can't do that, and you said you were going to stop. And I just feel like, you know, when I'm here, like, I want it, and I want to do it, but I have such a hard time, like, really following through with it.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""",27.08,59.52
053_003,053,3,2,"The thought is like, I can't go back from this, you know what I mean? Like, if I do it, it's final because he's going to think it's a good idea and then if I change my mind, he's not going to let me. It's like I'm giving up control, I guess.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching.""
Patient: ""I don't know, I was just about to ask you, like, how do I, like, you know, when I'm here, I feel like I want to do it, like I want to, like, get the alcohol out of the house and stuff, but then when I get home, I'm like, You know, if I tell my boyfriend we had to get the alcohol out of the house, then if I tell him later that I want it, then he's going to, you know, tell me, well, you can't do that, and you said you were going to stop. And I just feel like, you know, when I'm here, like, I want it, and I want to do it, but I have such a hard time, like, really following through with it.""
Therapist: ""So the step of getting it out of the house could be challenging. Yeah. Yeah. What would be the thought that would go through your mind as you go home today and you're getting ready to tell him you don't want the alcohol?""",80.98,100.49
053_005,053,5,4,"Yeah, and that's scary because I don't know if it's the right thing. I don't know. I don't know if I can do it.","Therapist: ""So the step of getting it out of the house could be challenging. Yeah. Yeah. What would be the thought that would go through your mind as you go home today and you're getting ready to tell him you don't want the alcohol?""
Patient: ""The thought is like, I can't go back from this, you know what I mean? Like, if I do it, it's final because he's going to think it's a good idea and then if I change my mind, he's not going to let me. It's like I'm giving up control, I guess.""
Therapist: ""So there's a sense of finality and seriousness in this decision. Like, I'm really committing not to drink. Yeah, yeah. And it might not be reversible.""",114.53,121.22
053_007,053,7,2,"I guess maybe like asking him if we can only have it in the house on the weekends. That could be helpful because then, like, it's not so final, you know. Maybe if I, like... I don't know. Like, it won't keep me from getting it forever, but it'll put me in a better situation, I guess, to function better when I need to.","Therapist: ""So there's a sense of finality and seriousness in this decision. Like, I'm really committing not to drink. Yeah, yeah. And it might not be reversible.""
Patient: ""Yeah, and that's scary because I don't know if it's the right thing. I don't know. I don't know if I can do it.""
Therapist: ""Yes, you might be putting yourself in a situation where actually getting the alcohol would be hard. And then you'd be without it for a while. That's frightening for you. Is there an intermediate step?""",151.27,175.25
053_009,053,9,2,"Yeah, I think that might be a lot better.","Therapist: ""Yes, you might be putting yourself in a situation where actually getting the alcohol would be hard. And then you'd be without it for a while. That's frightening for you. Is there an intermediate step?""
Patient: ""I guess maybe like asking him if we can only have it in the house on the weekends. That could be helpful because then, like, it's not so final, you know. Maybe if I, like... I don't know. Like, it won't keep me from getting it forever, but it'll put me in a better situation, I guess, to function better when I need to.""
Therapist: ""Because you wouldn't be drinking during the week. So, you would still have access to it, so it wouldn't be as scary. Because you could still go on the weekends. And then if you decide you want to stop drinking altogether, you just have to turn off the weekends.""",192.56,194.58
053_011,053,11,2,"I feel like that's, like, possible. Like, I can do that.","Therapist: ""Because you wouldn't be drinking during the week. So, you would still have access to it, so it wouldn't be as scary. Because you could still go on the weekends. And then if you decide you want to stop drinking altogether, you just have to turn off the weekends.""
Patient: ""Yeah, I think that might be a lot better.""
Therapist: ""So you're reducing...""",195.68,199.25
053_013,053,13,2,"I guess maybe just, like, you know, I know you want me to get a job, and sometimes I feel like my drinking makes it a little bit harder for me, because on the weekdays it just, it throws everything out of whack, so, you know, if maybe we could just, you know, if you want to drink on the weekdays, that's fine, but if you could just get it that day and drink it then, and if we could not keep any alcohol in the house on the weekdays, then that might help me a little bit. And I think that he would be okay with that, because he really wants me to get a job and stuff, so... All right.","Therapist: ""So you're reducing...""
Patient: ""I feel like that's, like, possible. Like, I can do that.""
Therapist: ""All right. So do you have something in mind to tell your boyfriend today when you go home? Like, do you have a script?""",210.65,249.59
053_017,053,17,2,"Yeah, yeah. I feel like that's manageable.","Therapist: ""So... Do you want to... You want to go ahead and say that to him when you go home?""
Patient: ""Yeah, I think I'm going to do that.""
Therapist: ""Yeah. That's a step you feel like you could take?""",264.35,266.71
053_021,053,21,1,Probably like a seven. I really think I can do it. I think so.,"Therapist: ""Seems like he'd be supportive of anything that's going to reduce the amount of... than alcohol.""
Patient: ""I think so.""
Therapist: ""So how confident, in terms of percentage, how confident are you that you'll be able to do that today?""",284.76,290.05
053_023,053,23,2,"I do. I'd probably give it like an eight or a nine. It's a little bit scary, but I think that it needs to happen. I need to do something. And I feel like it's something that's within my reach. I can do it.","Therapist: ""So how confident, in terms of percentage, how confident are you that you'll be able to do that today?""
Patient: ""Probably like a seven. I really think I can do it. I think so.""
Therapist: ""And how do you feel about the strategy overall? Like, do you have a good feeling about it? Are you scared of it?""",297.86,314.41
053_025,053,25,2,Maybe. I don't know. Maybe.,"Therapist: ""And how do you feel about the strategy overall? Like, do you have a good feeling about it? Are you scared of it?""
Patient: ""I do. I'd probably give it like an eight or a nine. It's a little bit scary, but I think that it needs to happen. I need to do something. And I feel like it's something that's within my reach. I can do it.""
Therapist: ""It may not be a goal of stopping altogether, but it's a goal that you can achieve. Reducing the amount is something you really feel like you could achieve. And it may make you feel a little better and more able to work, maybe even full time.""",336.94,339.74
054_001,054,1,2,"I don't know, like, it probably would, but I just don't really like to do anything else.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So we have this plan with kind of removing alcohol from the house and blocking access to it, at least during the week, and the walking, the work. And I remember before you were talking about how you couldn't walk. at night, because of the neighborhood, and also it's dark when you get home. I'm wondering if any other form of exercise could give you a similar feeling as walking does.""",58.43,64.06
054_003,054,3,4,"Yeah, like I just feel like an idiot if I do something in my house, you know what I mean? Like by myself, it just feels weird. I can't really afford like a gym membership or anything like that, so.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So we have this plan with kind of removing alcohol from the house and blocking access to it, at least during the week, and the walking, the work. And I remember before you were talking about how you couldn't walk. at night, because of the neighborhood, and also it's dark when you get home. I'm wondering if any other form of exercise could give you a similar feeling as walking does.""
Patient: ""I don't know, like, it probably would, but I just don't really like to do anything else.""
Therapist: ""Like walking's what you like to do?""",67.46,79.56
054_005,054,5,2,"Maybe I'll start trying to do it after my work program, like at noon when I would usually have lunch at a regular job.","Therapist: ""Like walking's what you like to do?""
Patient: ""Yeah, like I just feel like an idiot if I do something in my house, you know what I mean? Like by myself, it just feels weird. I can't really afford like a gym membership or anything like that, so.""
Therapist: ""Well, just an idea. Like something, maybe something could give it that same effect. If you can get the walking in and lunch, that would certainly be a step in the right direction for you.""",90.71,101.96
054_007,054,7,2,"Yeah, I do. Like, I feel like there's a little bit of hope. And I wasn't really feeling like that when I first came in, so that's a good thing.","Therapist: ""Well, just an idea. Like something, maybe something could give it that same effect. If you can get the walking in and lunch, that would certainly be a step in the right direction for you.""
Patient: ""Maybe I'll start trying to do it after my work program, like at noon when I would usually have lunch at a regular job.""
Therapist: ""Kind of get things started. In advance of the full-time job. All right. So, do you feel like today, today's session has been helpful as you kind of struggle with these various problems?""",117.67,127.23
054_009,054,9,1,"I guess like a good amount, not too much. Like I feel better about it right now because I have like a plan of what to do.","Therapist: ""Kind of get things started. In advance of the full-time job. All right. So, do you feel like today, today's session has been helpful as you kind of struggle with these various problems?""
Patient: ""Yeah, I do. Like, I feel like there's a little bit of hope. And I wasn't really feeling like that when I first came in, so that's a good thing.""
Therapist: ""Before we wrap up today, I hope I can see you next week. Let me schedule something for next week. I wanted to revisit the core belief that you brought up earlier. And we kind of know moving forward in terms of the walking and the conversation with your boyfriend. But I want to touch on the core belief. How much do you believe... that statement that you are a loser, that poor belief?""",168.52,175.47
054_015,054,15,2,Maybe.,"Therapist: ""Somewhere in the middle. Would it be meaningful in some way for you to know that I don't believe it at all? I believe that you believe it, but I don't believe you're a loser at all.""
Patient: ""No?""
Therapist: ""I don't believe it. I can appreciate how these beliefs form and the consequences they have, and it's normal for people to feel that way, but I don't think you're a loser. Actually, I think you have quite a few strengths and positive characteristics. And I'm wondering if you don't really give yourself full credit for that. And that might be part of what's going on. I think you're willing to see the negative side. And maybe you're missing what somebody on the outside like me can see.""",247.78,250.09
054_019,054,19,2,"Yeah, yeah. Okay.","Therapist: ""So, maybe one other thing you can... consider this week is that you may be not completely correct in this negative thinking. That there are other perspectives that could be accurate. That you're not a loser and that's just what you've come to believe because of all these various things you've been exposed to in your life. Different contributions could be made to that way of thinking, but I would challenge it. I would ask you this week to challenge that core belief. The tendency, which I can appreciate, is to just believe it. It comes up. It says to you, you're a loser. It's easy just to say, well, that must be true, and walk away. But I think that what I would ask you to do is stand up to it and challenge that.""
Patient: ""How do I do that?""
Therapist: ""That's a good question. I think that one way, is when you're aware of a thought that's tied directly that core belief like when you have a thought and and you realize this is really coming from the i'm a loser core belief that we talked about that self-talk you you apply that and we can work in session to create those you apply that right that moment and you're assertive in that self-statement yeah okay yeah you're you're standing up to it by by not only reciting the self-talk, but by really investing and believing in the self-talk. Does that make sense?""",349.1,351.78
054_021,054,21,4,"Kind of like when I think that I can't work full-time, I'm not going to be successful, and that I can't support myself.","Therapist: ""That's a good question. I think that one way, is when you're aware of a thought that's tied directly that core belief like when you have a thought and and you realize this is really coming from the i'm a loser core belief that we talked about that self-talk you you apply that and we can work in session to create those you apply that right that moment and you're assertive in that self-statement yeah okay yeah you're you're standing up to it by by not only reciting the self-talk, but by really investing and believing in the self-talk. Does that make sense?""
Patient: ""Yeah, yeah. Okay.""
Therapist: ""And I would look forward to building with you, building more of these adaptive responses, self-talk, that you can use. So one way to get started with this could be to identify those thoughts I was just talking about. Write them down and bring them in.""",371.46,378.31
054_023,054,23,2,"Yeah, I guess I never really thought about it like that.","Therapist: ""And I would look forward to building with you, building more of these adaptive responses, self-talk, that you can use. So one way to get started with this could be to identify those thoughts I was just talking about. Write them down and bring them in.""
Patient: ""Kind of like when I think that I can't work full-time, I'm not going to be successful, and that I can't support myself.""
Therapist: ""Yeah, all those thoughts really seem to tie back to that core belief.""",382.88,385.22
054_027,054,27,1,Okay.,"Therapist: ""So confront them as you see fit, as best you can, but also write them down and bring them in, and let's work through them.""
Unknown: ""Okay.""
Therapist: ""I'm glad you brought that up. That's a really great question and kind of moves to an important point, that we need to have a strategy going forward that you can kind of collect the thoughts that you need to dispute so we can work out how to dispute them in session.""",416.23,418.37
055_001,055,1,1,I'm all right. You're all right? Mm-hmm.,"Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Hello, Sarah. How are you doing today?""",28.89,32.64
055_003,055,3,4,"Yeah, I've been really stressed out at work. I just... I'm getting to the point where it's really hard to handle things that are going on.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Hello, Sarah. How are you doing today?""
Patient: ""I'm all right. You're all right? Mm-hmm.""
Therapist: ""I understand that you've come to counseling because you have a particular issue that's been bothering you recently.""",43.18,50.41
055_005,055,5,2,Mm-hmm.,"Therapist: ""I understand that you've come to counseling because you have a particular issue that's been bothering you recently.""
Patient: ""Yeah, I've been really stressed out at work. I just... I'm getting to the point where it's really hard to handle things that are going on.""
Therapist: ""So, work-related problems?""",53.46,55.66
055_007,055,7,2,"Mm-hmm. I think I need to, yeah.","Therapist: ""So, work-related problems?""
Patient: ""Mm-hmm.""
Therapist: ""Are you okay talking about that today?""",57.8,60.57
055_013,055,13,2,"No, I think, as long as you think I can tell my whole story in enough time.","Therapist: ""Does that seem like a fairly straightforward agenda?""
Patient: ""Yeah.""
Therapist: ""Any changes or anything you'd like to make to that?""",156.24,160.02
055_021,055,21,5,"Okay, so I'm a case worker and, you know, what I do, I usually go into people's homes and, you know, talk to the families, do inspections, that kind of thing. And, you know, I've been doing it for a while now, not too long, but about five years. And overall, I like my job and everything. But just, you know, something happened at work and it just really kind of, I just feel like one minute everything was fine and now it just feels like everything's really out of control. So, you know, I was just, you know, doing my normal job, making reports and everything like that. And, you know, I made a report about this family that I felt, you know, maybe the children weren't getting quite what they needed. They seemed malnourished. The house was really unclean. You know, I suspected that the parents were using drugs there, and it's just really not a good environment. And, you know, it turns out that the kids were taken away, and, you know, the family, it just, I'm like really freaked out, you know, maybe the kids aren't doing well, they're away from their parents, even though it wasn't a great environment, I know that the kids really love their parents, and it's just, it's really, really weighing on me. And it's become kind of like a really big issue at work, I guess, where like everybody knows about it and, you know, I just feel like I tore this family apart and I don't know if I made the right decision and I just, it's like, you know, I used to just, I used to be so confident in what I did and now I just feel like I'm second-guessing everything.","Therapist: ""But just know that overall that's kind of what I'm thinking about for the structure.""
Patient: ""Okay.""
Therapist: ""And then, you know, as we wrap up, we'll set to make an appointment next time, and Like I said, we'll end up with some ideas. I hope they can help you. So, let's get started with kind of, you know, your experience with all this. So, tell me about your job.""",195.73,292.49
055_025,055,25,4,"Yeah. It's making me not like my job. Like, I wake up in the morning and I'm like, I should just pretend I'm sick. I don't want to go, you know. I just feel like, you know, at night I'm more stressed out. You know, maybe I have an extra glass of wine and I just feel so...","Therapist: ""So this is really stressful on you.""
Patient: ""Yeah.""
Therapist: ""So you like Just so I make sure I understand, you like your job, but this dealing you've had with this particular family and what happened as a result of that dealing has just really thrown you for a loop.""",311.17,327.16
055_027,055,27,4,"Yeah, I Used to enjoy going to work and you know feel fulfilled and now I just feel like I do not want to go at all So there's a sense of dread Anxiety.","Therapist: ""So you like Just so I make sure I understand, you like your job, but this dealing you've had with this particular family and what happened as a result of that dealing has just really thrown you for a loop.""
Patient: ""Yeah. It's making me not like my job. Like, I wake up in the morning and I'm like, I should just pretend I'm sick. I don't want to go, you know. I just feel like, you know, at night I'm more stressed out. You know, maybe I have an extra glass of wine and I just feel so...""
Therapist: ""edge all the time So it's it's really drastically changed your work experience.""",334.05,345.94
055_029,055,29,4,"Yeah, definitely. I think anxiety more so, but I definitely feel down. Like, you know, even on the weekends, sometimes I just wake up and I want to stay in bed and, you know, I just, I feel like I'm having a good time and then I remember what happened and it just brings me back to that place and I'm just, I don't like it.","Therapist: ""edge all the time So it's it's really drastically changed your work experience.""
Patient: ""Yeah, I Used to enjoy going to work and you know feel fulfilled and now I just feel like I do not want to go at all So there's a sense of dread Anxiety.""
Therapist: ""Yeah, you feel down at all""",350.73,369.38
056_001,056,1,4,"Yeah. It's making me think, like, you know, if I just had some desk job, like, if I just crunched numbers or something, I would never have to have this responsibility. Like, why would they trust me with a job like this? Like, I'm just a human being who, you know, doesn't know any better than any other person, and I just don't know if I can do this. It's just so much responsibility, and I guess... I guess before I felt like I could handle it and now I just feel like it's so much responsibility for one person and I don't think that I can handle it anymore. But I don't want to change jobs because I've been here for so long and I liked it before and... I don't know.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Has it made you rethink your entire job and the profession you're in?""",35.98,78.91
056_005,056,5,5,"I feel like it's just around the corner. And this isn't even resolved. I'm still afraid of the consequences of this, you know? Like, what if, you know, these kids are out of their parents' home, and I just feel like, what if something bad happens to them where they are now? And then that's going to fall on me. And, you know, people, like, my co-workers know that I'm the one that did this, so, like, if something happens to the kids, like, I'm going to be the one that they're going to blame for it.","Therapist: ""You're fearful of this happening again.""
Patient: ""Yes, yes.""
Therapist: ""And how you may handle it, what may happen.""",85.84,114.61
056_007,056,7,3,"Yeah, because, you know, before that, I guess, you know, probably nobody else would have known about it. So I made the report about what was going on, and I think, yeah, as a direct result.","Therapist: ""And how you may handle it, what may happen.""
Patient: ""I feel like it's just around the corner. And this isn't even resolved. I'm still afraid of the consequences of this, you know? Like, what if, you know, these kids are out of their parents' home, and I just feel like, what if something bad happens to them where they are now? And then that's going to fall on me. And, you know, people, like, my co-workers know that I'm the one that did this, so, like, if something happens to the kids, like, I'm going to be the one that they're going to blame for it.""
Therapist: ""So... Just to make sure I understand, your report... So they were engaging in these behaviors, and your report is what precipitated them being broken up?""",130.08,144.72
056_009,056,9,2,"I don't know. I mean, it wasn't going great for the kids. It wasn't really a great environment, but I just feel like if I had left it alone, I don't know, that the kids would be with their parents.","Therapist: ""So... Just to make sure I understand, your report... So they were engaging in these behaviors, and your report is what precipitated them being broken up?""
Patient: ""Yeah, because, you know, before that, I guess, you know, probably nobody else would have known about it. So I made the report about what was going on, and I think, yeah, as a direct result.""
Therapist: ""All right, let's take a look at... The evidence right so in in CBT we like to evaluate evidence and try to look at The facts as we understand them And really we want to scrutinize and carefully review the facts and the evidence and hold a light to it and Try to figure out what's going on. All right What would have happened? with this family if you hadn't, or if no one intervened?""",179.85,194.17
056_011,056,11,2,"Yeah, I mean, I guess... I guess I feel like it probably wasn't great for them to be there. I mean, that's why I made the report. That's my job. But it just feels like, you know... It just feels like I'm playing God, you know what I mean? Like, that I'm just coming in here and spend, like, five, ten minutes with a family and then turn their whole world upside down.","Therapist: ""All right, let's take a look at... The evidence right so in in CBT we like to evaluate evidence and try to look at The facts as we understand them And really we want to scrutinize and carefully review the facts and the evidence and hold a light to it and Try to figure out what's going on. All right What would have happened? with this family if you hadn't, or if no one intervened?""
Patient: ""I don't know. I mean, it wasn't going great for the kids. It wasn't really a great environment, but I just feel like if I had left it alone, I don't know, that the kids would be with their parents.""
Therapist: ""So they'd all be together. And you feel like right now with them, you think with them being apart, that's not as good as if they're together.""",207.43,229.06
056_013,056,13,3,"Well, I mean, like I said, I thought they were using drugs in the home, so that's like a really dangerous situation for kids to be in because you don't know. what kind of people are coming in and out of the home, if the parents are going to be coherent enough to help them if there's an emergency, or if the parents are even making them food and taking care of their needs and stuff like that. So I guess in that sense, that's really concerning. And that's a big part of the reason why I made the report.","Therapist: ""So they'd all be together. And you feel like right now with them, you think with them being apart, that's not as good as if they're together.""
Patient: ""Yeah, I mean, I guess... I guess I feel like it probably wasn't great for them to be there. I mean, that's why I made the report. That's my job. But it just feels like, you know... It just feels like I'm playing God, you know what I mean? Like, that I'm just coming in here and spend, like, five, ten minutes with a family and then turn their whole world upside down.""
Therapist: ""So you have a tremendous amount of power. Mm-hmm. And if you misuse that power... You could devastate families. That's maybe what you think happened here. Yeah. All right, so going back to what would have happened to them, let me just step back there for a moment. They would still be together without your intervention, and that could be a positive. What about consequences that may be more negative?""",259.8,285.4
056_017,056,17,4,"I don't know. I guess that's just the hardest part for me, is like, I feel like I can't make the right decision. I just feel like I don't know if I'm equipped to be the person to make that kind of decision.","Therapist: ""So you made the report because it's your responsibility, but also you had concerns about their welfare.""
Patient: ""Yeah.""
Therapist: ""If you could go back and do it again, would you change anything?""",303.86,314.07
057_001,057,1,4,I'm going to have to hear what my coworkers have to say about what's going on. I might make another mistake. Who knows if I'm going to find out that something terrible happened to these kids when I go back to work. I guess a lot of stuff like that.,"Therapist: ""hi this is dr. Grande I hope you find this video useful if that's the case please like it and subscribe to my channel as always thanks for watching so you mentioned before that when you wake up in the morning you you don't want to go to work what's going through your mind""",40.95,55.04
057_003,057,3,5,"I feel more anxious. You know, I think about, like, what could happen to somebody else if I make a mistake, like kids going to the wrong home or, you know, not being with their parents when their parents, you know, were not doing anything wrong, and I just feel really, like, overwhelmed, and it gets hard to breathe, and I just want to go back to sleep and not have to face anything.","Therapist: ""hi this is dr. Grande I hope you find this video useful if that's the case please like it and subscribe to my channel as always thanks for watching so you mentioned before that when you wake up in the morning you you don't want to go to work what's going through your mind""
Patient: ""I'm going to have to hear what my coworkers have to say about what's going on. I might make another mistake. Who knows if I'm going to find out that something terrible happened to these kids when I go back to work. I guess a lot of stuff like that.""
Therapist: ""So looking at the one, I'm going to make a mistake, this kind of connects to what we were talking about before. This is the uncertainty. You're not sure of your own skills. And you're afraid of an error that's going to be costly. So when you think that thought, I'm going to make a mistake. So this is when you're in bed before you start your day. And you have that thought. What happens right then?""",90.23,114.4
057_005,057,5,4,I've been late a lot more lately because I have trouble getting out of bed.,"Therapist: ""So looking at the one, I'm going to make a mistake, this kind of connects to what we were talking about before. This is the uncertainty. You're not sure of your own skills. And you're afraid of an error that's going to be costly. So when you think that thought, I'm going to make a mistake. So this is when you're in bed before you start your day. And you have that thought. What happens right then?""
Patient: ""I feel more anxious. You know, I think about, like, what could happen to somebody else if I make a mistake, like kids going to the wrong home or, you know, not being with their parents when their parents, you know, were not doing anything wrong, and I just feel really, like, overwhelmed, and it gets hard to breathe, and I just want to go back to sleep and not have to face anything.""
Therapist: ""So there's an emotional consequence, and then the behavior is you don't want to get out of bed.""",127.31,130.56
057_007,057,7,2,"Yeah. I mean, if I don't go back to sleep, then I have more thoughts like, you know, well, I need to go to work. If I don't go to work, then I'm going to be late. Then people are going to notice me and they're going to be thinking about what happened and thinking there's something wrong with me and that she's not good enough to do her job, you know. I don't want people to know how stressed out I am because then they're going to doubt my abilities just like I do.","Therapist: ""So there's an emotional consequence, and then the behavior is you don't want to get out of bed.""
Patient: ""I've been late a lot more lately because I have trouble getting out of bed.""
Therapist: ""And when you're staying in bed, are there more thoughts coming up?""",136.42,162.63
057_009,057,9,4,"Yeah, they're keeping me from getting to work and stuff like that.","Therapist: ""And when you're staying in bed, are there more thoughts coming up?""
Patient: ""Yeah. I mean, if I don't go back to sleep, then I have more thoughts like, you know, well, I need to go to work. If I don't go to work, then I'm going to be late. Then people are going to notice me and they're going to be thinking about what happened and thinking there's something wrong with me and that she's not good enough to do her job, you know. I don't want people to know how stressed out I am because then they're going to doubt my abilities just like I do.""
Therapist: ""So this is really weighing on you. And you've identified these thoughts that seem to be connected with feelings that are unpleasant and behaviors that are unpleasant, but also maybe not useful. They're impeding.""",182.02,184.5
057_011,057,11,2,"Right now in this moment, probably like a five.","Therapist: ""So this is really weighing on you. And you've identified these thoughts that seem to be connected with feelings that are unpleasant and behaviors that are unpleasant, but also maybe not useful. They're impeding.""
Patient: ""Yeah, they're keeping me from getting to work and stuff like that.""
Therapist: ""So we have a reference point for later on as we continue counseling. I'd like to scale this problem, like maybe on a scale of 1 to 10, where 10 represents feelings that are nearly unbearable, right? And 1, not really a problem. How do you feel... On that scale, where do you rate yourself right now?""",217.21,219.45
057_013,057,13,2,"Yeah, like I'm really stressed out, but I'm not like when I'm in bed, like I can't get out of bed, that kind of thing.","Therapist: ""So we have a reference point for later on as we continue counseling. I'd like to scale this problem, like maybe on a scale of 1 to 10, where 10 represents feelings that are nearly unbearable, right? And 1, not really a problem. How do you feel... On that scale, where do you rate yourself right now?""
Patient: ""Right now in this moment, probably like a five.""
Therapist: ""That's right around the middle.""",221.67,227.36
057_017,057,17,4,"With this feeling, it's about as bad as it gets. Maybe sometimes it gets to a nine. You know, I still feel like I can function, but it's really, really difficult.","Therapist: ""How would you rate yourself when you're in bed before you go to work?""
Patient: ""Probably like an eight.""
Therapist: ""Is that as bad as it gets?""",238.27,249.04
058_003,058,3,2,"Okay. I like my job because I felt like I was helping people, so it was meaningful. And, you know, when I went there, time went by fast, so it was kind of like I was enjoying myself, you know. Not super fast, I wasn't having the best time of my life, but it was something where I would go and, you know, I felt like I was doing something important and the day didn't drag on and, you know, I got along with my coworkers and that kind of thing. So it felt meaningful to me.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Would you be okay now kind of taking a look at some of your thinking and the situation from that point of view? Okay. Some things kind of stand out for me in hearing you talk about what's been happening in your feelings, I can appreciate it's really painful. And I would say to the degree that you can step back and try to look at the thoughts, I think that you'll see it's helpful. Although I know it's a little difficult or unusual to separate feelings from thoughts sometimes. But I'd like to try to kind of distinguish between the two. You said that you've been at your job for about five years. You really like your job.""
Patient: ""I used to, yeah.""
Therapist: ""Tell me about your job, like, kind of how you felt about it, but frame it in a time before this ever happened.""",89.43,119.91
058_005,058,5,1,"Yeah, I feel like, you know, doing my job, I got to know people, you know, help people out with things that they needed. You know, when things were bad, I could, you know, get kids out of situations that were really dangerous for them. And, you know, no one else was going to do that for them. So I felt like I was the kind of person that was making, keeping people safe, I guess.","Therapist: ""Tell me about your job, like, kind of how you felt about it, but frame it in a time before this ever happened.""
Patient: ""Okay. I like my job because I felt like I was helping people, so it was meaningful. And, you know, when I went there, time went by fast, so it was kind of like I was enjoying myself, you know. Not super fast, I wasn't having the best time of my life, but it was something where I would go and, you know, I felt like I was doing something important and the day didn't drag on and, you know, I got along with my coworkers and that kind of thing. So it felt meaningful to me.""
Therapist: ""Meaningful. So do you remember accomplishing things at that job that you felt benefited society, the people you helped?""",133.69,163.01
058_009,058,9,4,"Risk yeah, I was just about to say it feels dangerous To be there like to do my job.","Therapist: ""You kept people safe. And you had a lot of satisfaction from the work you did. And now, it doesn't feel that way?""
Patient: ""No, not at all.""
Therapist: ""The way you described it, it almost sounds like you're... Well, you talked about how you're afraid of making that mistake. You're thinking about yourself in a way where you're almost...""",197.52,204.56
058_011,058,11,2,"I mean, I guess it's like quantitatively the same as before. I do the same things with families, but now I kind of feel like I can't trust my own judgment. Like, everything... Before, everything just kind of felt a little more black and white, and now it just feels like everything is so much a shade of gray that I just can't tell, you know, what's right and what's wrong anymore. And every time I feel like I have a good instinct, I doubt it, I question it. I have all these ideas of, well, you know, if I remove the kids from this family, what if they're not really doing the things I think they're doing? Like, what if the parents are actually good parents? What if the kids get put into a home that's bad for them?","Therapist: ""The way you described it, it almost sounds like you're... Well, you talked about how you're afraid of making that mistake. You're thinking about yourself in a way where you're almost...""
Patient: ""Risk yeah, I was just about to say it feels dangerous To be there like to do my job.""
Therapist: ""It feels dangerous Your your work right now even though you have this one Situations extremely stressful and hard on you. Mm-hmm. You have other families that you interact with now, too You tell me about those interactions""",225.47,271.26
058_014,058,14,5,"Yeah, sometimes it was tougher than others, but it just seemed more like I could make a decision and kind of wipe my hands of it and, you know, move on to the next thing. And now I just feel like there's all these doubts in my head and all these questions about if I'm doing the right thing.","Patient: ""I mean, I guess it's like quantitatively the same as before. I do the same things with families, but now I kind of feel like I can't trust my own judgment. Like, everything... Before, everything just kind of felt a little more black and white, and now it just feels like everything is so much a shade of gray that I just can't tell, you know, what's right and what's wrong anymore. And every time I feel like I have a good instinct, I doubt it, I question it. I have all these ideas of, well, you know, if I remove the kids from this family, what if they're not really doing the things I think they're doing? Like, what if the parents are actually good parents? What if the kids get put into a home that's bad for them?""
Therapist: ""So before, so this is maybe what's different, based on what you're saying from before till now, is decisions seemed clear-cut.""
Unknown: ""Mm-hmm.""",283.76,299.76
058_016,058,16,2,"Yeah, yeah, definitely. I feel like I'm second-guessing everything.","Unknown: ""Mm-hmm.""
Patient: ""Yeah, sometimes it was tougher than others, but it just seemed more like I could make a decision and kind of wipe my hands of it and, you know, move on to the next thing. And now I just feel like there's all these doubts in my head and all these questions about if I'm doing the right thing.""
Therapist: ""All right. So you're looking inward. You're looking at yourself. A lot of self-doubt. You're looking at decisions as much more difficult... It's much more difficult to come to the right decision. And second-guessing, it sounds like maybe to your second-guessing a bit, when you do make a decision, like playing over your mind, what could go wrong here? Is that the thought you're having?""",332.18,336.24
059_001,059,1,2,"Yeah, I had this case, you know, recently where it's a single dad, the mom passed away, and I go in and check on him and his son, and, you know, things are going well, but, you know, I think the dad has a hard time, so it's not like it was before when the mom was there. Not that I wasn't there before that, but you can just tell that like things are a little different, but You know obviously my decision is that things are going well for the kid You know they're gonna he's gonna stay there and dad is stable, but I Just worry like is the dad under too much stress Is he really taking care of the kid as good as you know what if he's just? Cleaning up the house and doing the right things while I'm there while I'm not there You know, does he have the energy to take care of his kid? Is everything really the way it appears, or is there more going on? I just don't know.","Therapist: ""Hi this is Dr. Grande I hope you find this video useful if that's the case please like it and subscribe to my channel as always thanks for watching so can you think of another case you're working on another family different than the one that we've initially talked about where you've made a decision that seemed like it was fairly clear-cut, like one you would have made before, and yet you're thinking about it, replaying it?""",49.88,108.83
059_003,059,3,4,"Yeah, and it's like I can't let it go, like, saw him like two weeks ago and i still wonder and i have other cases like that it's like they're all running through my head and i have these thoughts like did i do the right thing can i do the right thing maybe what if what if the worst happens and i didn't see it like what if something terrible happens and i should have known better so it speaks back to","Therapist: ""Hi this is Dr. Grande I hope you find this video useful if that's the case please like it and subscribe to my channel as always thanks for watching so can you think of another case you're working on another family different than the one that we've initially talked about where you've made a decision that seemed like it was fairly clear-cut, like one you would have made before, and yet you're thinking about it, replaying it?""
Patient: ""Yeah, I had this case, you know, recently where it's a single dad, the mom passed away, and I go in and check on him and his son, and, you know, things are going well, but, you know, I think the dad has a hard time, so it's not like it was before when the mom was there. Not that I wasn't there before that, but you can just tell that like things are a little different, but You know obviously my decision is that things are going well for the kid You know they're gonna he's gonna stay there and dad is stable, but I Just worry like is the dad under too much stress Is he really taking care of the kid as good as you know what if he's just? Cleaning up the house and doing the right things while I'm there while I'm not there You know, does he have the energy to take care of his kid? Is everything really the way it appears, or is there more going on? I just don't know.""
Therapist: ""Alright, so you're handling it to the best of your ability, but there's still these thoughts that are coming up, kind of encouraging you to second guess your judgment.""",123.99,152.6
059_009,059,9,5,"Yeah, I mean, I think that that's probably true, because before I felt fine, and now I just feel like everything's falling apart, and not that much has changed, and so it kind of makes me think that that's probably what's going on, but I don't know how to change that.","Therapist: ""A lot of things you, or several things you talk about seem to connect back to are you capable to be in this field? And should you be trusted?""
Patient: ""Yeah, definitely.""
Therapist: ""So, on the, kind of moving back to thinking, There are errors in thinking that all people make. And when these errors become repetitive, and you can kind of see them applied in more than one area of somebody's life, we refer to that as a cognitive distortion. Okay. It's not bad or good. It's just how people think. It's just patterns that people fall into. And there are several different cognitive distortions. There are several patterns that we kind of see come up often in this work as a counselor. I'm wondering, in this situation where you're thinking the worst possible outcome is unbearable or likely or both, if you may be really focusing and emphasizing on that to the exclusion of other evidence that suggests you've made a good decision. So you're really focused on the negative outcome, the worst possible and maybe even unlikely outcome, and maybe not weighing all the evidence with the same weight, like you're putting more weight on the negative. Does that kind of make sense?""",273.51,288.37
060_001,060,1,1,"I had my bachelor's degree, and we got a little bit of training. You know, every so often we get some training at work and stuff like that.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So, all right, let's take a step back and talk about competency. What education did you need for the job you have now?""",36.57,43.34
060_003,060,3,1,"Yeah, I have a supervisor, so they check up on stuff, and also, like, if I feel like I have questions and stuff like that, I can go to them as well.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So, all right, let's take a step back and talk about competency. What education did you need for the job you have now?""
Patient: ""I had my bachelor's degree, and we got a little bit of training. You know, every so often we get some training at work and stuff like that.""
Therapist: ""Are you evaluated at work by anybody to see if you're doing the job you should be?""",49.27,57.34
060_005,060,5,2,"Yeah, I mean, I haven't been fired, so that's a good sign, I guess.","Therapist: ""Are you evaluated at work by anybody to see if you're doing the job you should be?""
Patient: ""Yeah, I have a supervisor, so they check up on stuff, and also, like, if I feel like I have questions and stuff like that, I can go to them as well.""
Therapist: ""Have you been found in that system to be somebody who's satisfying the requirements of, in terms of competency, satisfying the requirements of an employee?""",72.16,75.42
060_007,060,7,2,"No, I just... I kind of feel like maybe the climate has changed a little bit at the office after this happened. Like, maybe other people think I didn't make the right decision. I guess maybe that's part of where all my doubts are coming from. Like, no one has... said to me and i haven't you know my supervisor hasn't called me in and said i'm concerned about this but i just feel like maybe other people think that i did something wrong all right so there's no there's no um evidence supporting that in a kind of a direct fashion like a supervisor coming to you but there's other evidence supporting it","Therapist: ""Have you been found in that system to be somebody who's satisfying the requirements of, in terms of competency, satisfying the requirements of an employee?""
Patient: ""Yeah, I mean, I haven't been fired, so that's a good sign, I guess.""
Therapist: ""That's a good sign. Yeah. You haven't been fired. Have you ever had any type of write-up or somebody discussing something with you?""",87.24,126.29
060_009,060,9,2,"Yeah. You're getting this feeling that by the way they're interacting with you, by the way they're relating to you, that... Yeah, which I guess maybe I shouldn't be that freaked out about because there have been other people who have made mistakes and, like, the supervisors have talked to them and, you know, even then they didn't lose their jobs, so it's not like, you know, I have, you know... I don't know. I guess it's not like just hearing them or thinking that they're judging me is an indication that something terrible is going to happen or that I made this huge mistake.","Therapist: ""That's a good sign. Yeah. You haven't been fired. Have you ever had any type of write-up or somebody discussing something with you?""
Patient: ""No, I just... I kind of feel like maybe the climate has changed a little bit at the office after this happened. Like, maybe other people think I didn't make the right decision. I guess maybe that's part of where all my doubts are coming from. Like, no one has... said to me and i haven't you know my supervisor hasn't called me in and said i'm concerned about this but i just feel like maybe other people think that i did something wrong all right so there's no there's no um evidence supporting that in a kind of a direct fashion like a supervisor coming to you but there's other evidence supporting it""
Therapist: ""based on what you're feeling and how you're maybe perceiving things.""",131.76,164.48
060_011,060,11,2,"Yeah, it's kind of like, I know it's not that big of a deal because, like I said, my supervisor hasn't talked to me, and it's not like I've heard anything terrible about anything happening to the kids or anything like that, but I just feel like, you know, I have those thoughts like, oh, was she, you know, saying something? You know, when she said that, was she referring to what happened? And stuff like that.","Therapist: ""based on what you're feeling and how you're maybe perceiving things.""
Patient: ""Yeah. You're getting this feeling that by the way they're interacting with you, by the way they're relating to you, that... Yeah, which I guess maybe I shouldn't be that freaked out about because there have been other people who have made mistakes and, like, the supervisors have talked to them and, you know, even then they didn't lose their jobs, so it's not like, you know, I have, you know... I don't know. I guess it's not like just hearing them or thinking that they're judging me is an indication that something terrible is going to happen or that I made this huge mistake.""
Therapist: ""All right, so you can see that from talking this through, you can see that some of this could be feelings, thoughts you're having, combined with what you're actually observing. So you're filtering your observations in a way that's maybe making them seem a little more destructive, a little more negative.""",196.65,221.26
060_013,060,13,2,"Yeah, so, like, we were having... like our regular work meeting and we kind of like you know discuss how things are going and it's been kind of a big deal what you know more so than usual that the kids were removed from this family so you know one of my co-workers kind of nudged me and said like oh you're the bulldozer you know you plowed right through that family and took those kids away and you know I think she meant it kind of like as a joke and just you know, maybe to say, like, you know, you did what you needed to do. But it kind of made me feel like, does she think that I'm just callous? Like, does she think that I just didn't care? And, you know, you get what I'm saying?","Therapist: ""All right, so you can see that from talking this through, you can see that some of this could be feelings, thoughts you're having, combined with what you're actually observing. So you're filtering your observations in a way that's maybe making them seem a little more destructive, a little more negative.""
Patient: ""Yeah, it's kind of like, I know it's not that big of a deal because, like I said, my supervisor hasn't talked to me, and it's not like I've heard anything terrible about anything happening to the kids or anything like that, but I just feel like, you know, I have those thoughts like, oh, was she, you know, saying something? You know, when she said that, was she referring to what happened? And stuff like that.""
Therapist: ""Can you provide an example of an interaction with a co-worker where they said something that you thought maybe was referring back to this?""",235.72,278.74
060_015,060,15,2,"Yeah So you don't know exactly how she meant it, but you're thinking maybe it was Connected and I guess it kind of like it goes back to like my fear that I didn't think it through that I kind of just you know, I made the report and that was that and you know, I it makes me feel like was i being mechanical did i just was i just nonchalant about it should i have put more thought into it and it really you know it hit me where it hurt i guess you know so her saying that really kind of brought up this thought that maybe you are maybe you are not empathetic enough or compassion enough yeah or even just thoughtful i guess maybe i was just being you know just going about my job without putting a lot of thought into what i was doing exactly so maybe one thing you would have done differently in light of that comment at the time make a decision you would have thought through the steps more yeah maybe taken a little bit more time but at the same time i mean i don't have a ton of time i I've been good at my job, I've been doing things that way, but then it just kind of made me think, have I been missing stuff all along? I don't know.","Therapist: ""Can you provide an example of an interaction with a co-worker where they said something that you thought maybe was referring back to this?""
Patient: ""Yeah, so, like, we were having... like our regular work meeting and we kind of like you know discuss how things are going and it's been kind of a big deal what you know more so than usual that the kids were removed from this family so you know one of my co-workers kind of nudged me and said like oh you're the bulldozer you know you plowed right through that family and took those kids away and you know I think she meant it kind of like as a joke and just you know, maybe to say, like, you know, you did what you needed to do. But it kind of made me feel like, does she think that I'm just callous? Like, does she think that I just didn't care? And, you know, you get what I'm saying?""
Therapist: ""Yeah. Yeah. So she referred to you as a bulldozer. And one way to take that would be powerful, efficient. But another way to take that would be kind of... Destructive we talked about before destructive callous. They're mechanical. They don't have a lot of feeling.""",302.73,391.65
061_001,061,1,2,"Yeah, I think so. I mean, you're right to a certain extent. We have guidelines and everything like that. But I also feel like certain things that just isn't black and white and I have to make a judgment call. And I used to trust my judgment, but now I feel like, how do I know that I'm making the right decisions?","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Well, I could see these types of decisions where you're talking about potentially breaking families up and having real consequences to families. I could see how these decisions could be, I mean, I'm sure there's guidelines you've are supposed to follow that you really don't have a whole lot of choice in. But you could also really agonize and overanalyze a decision like that because the consequences are so grave. Do you feel like that could be happening?""",61.32,79.9
061_003,061,3,4,"Yeah, I think that's where the fear is, is that if 99 times out of a hundred I do it right, there's still going to be that one that I messed up. And I'm starting to feel like that one mistake could be life-changing for somebody.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Well, I could see these types of decisions where you're talking about potentially breaking families up and having real consequences to families. I could see how these decisions could be, I mean, I'm sure there's guidelines you've are supposed to follow that you really don't have a whole lot of choice in. But you could also really agonize and overanalyze a decision like that because the consequences are so grave. Do you feel like that could be happening?""
Patient: ""Yeah, I think so. I mean, you're right to a certain extent. We have guidelines and everything like that. But I also feel like certain things that just isn't black and white and I have to make a judgment call. And I used to trust my judgment, but now I feel like, how do I know that I'm making the right decisions?""
Therapist: ""Yeah. Well, and this is really one of the key parts of what may be causing this distress. We talked about this insecurity. You're unsure. And so, you know, one question may be, did you make... a efficient or less than efficient decision with this particular family, but the larger question is, you as a person, can you do this, this job, and if you do it, and make a mistake, what do you do then? Could you go through this again?""",125.23,144.91
061_005,061,5,2,"Yeah. I guess that's true, like... Yeah, maybe somebody else could come and replace me, but do I think that they would be better at it? I don't know. I feel like I was pretty good at it before I started to have all these doubts.","Therapist: ""Yeah. Well, and this is really one of the key parts of what may be causing this distress. We talked about this insecurity. You're unsure. And so, you know, one question may be, did you make... a efficient or less than efficient decision with this particular family, but the larger question is, you as a person, can you do this, this job, and if you do it, and make a mistake, what do you do then? Could you go through this again?""
Patient: ""Yeah, I think that's where the fear is, is that if 99 times out of a hundred I do it right, there's still going to be that one that I messed up. And I'm starting to feel like that one mistake could be life-changing for somebody.""
Therapist: ""And it could be. You're certainly in a job where, like most jobs where mistakes have consequences, you also do a lot of good for a lot of people. So by you not being in the field, they're not getting the benefit of the skills you have.""",166.09,180.59
061_009,061,9,4,"I don't know. That's a hard question. I mean, if they took my kids away, even if it was the right thing, I would want them to be at least a little bit, you know, feel a little bit bad about having to make such a hard decision. But I guess if they fell apart every time that they made that kind of decision, they wouldn't be able to help other people.","Therapist: ""So, mostly, this was good until this incident. Well, alright. Let's look at this From another point of view, you really seem like you can empathize with these families. You really... To me, it seems like you really know what they're feeling.""
Patient: ""Yeah, I care about them.""
Therapist: ""And appreciating their perspective. Take a moment and try to walk in their shoes. If a professional like yourself came to you in your family situation, and maybe you're engaged in the activities where it was warranted that your family would be broken up temporarily, how would you want them to process that? So thinking about the caseworker from the point of view of the family, How would you want them to feel about it? How would you want them to process that decision?""",253.07,275.9
061_013,061,13,3,"For the families that I took Yeah, I mean, I think that might be the problem is I have too much of it, you know. I worry about how they feel, even if maybe taking the kids away was the right thing. It's just like so devastating to lose your kids, whether you're doing the right things or not, you know. You want your kids with you. You want to be able to take care of them, even if you're not doing a really good job at it.","Therapist: ""So from the family's point of view, if you're in that situation, you can appreciate what the caseworker has to do, but you'd like them to have some compassion for you. Mm-hmm. Okay. That seems reasonable.""
Patient: ""Yeah.""
Therapist: ""So now flip back into the role you're in. You made the decision you had to make, although you're second-guessing it. That's separate. Do you have compassion for them?""",305.31,330.68
062_001,062,1,4,"Yeah, I guess maybe that's part of where it's so hard for me is like I know that I'm causing a lot of suffering for people.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Yes, you really get where they're coming from. You really understand the suffering involved.""",35.63,43.1
062_003,062,3,5,"I guess it's not like it's their actions. If they were doing the right things, even if I did come in, their kids wouldn't be removed. But it is still hard to be the one that holds that trigger, you know?","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Yes, you really get where they're coming from. You really understand the suffering involved.""
Patient: ""Yeah, I guess maybe that's part of where it's so hard for me is like I know that I'm causing a lot of suffering for people.""
Therapist: ""Well, let's talk about that. So you're in a position where you have to make some decisions about people's lives. And sometimes those decisions result in people being separated from their families. Sometimes they don't. Are you really the cause in the larger picture? Are you really the cause of these families being broken up?""",73.06,86.88
062_007,062,7,3,"Probably. I mean, if they get with a good family, which, you know, usually they do, It's good for them. Maybe it could be a wake-up call for the parents, or if not, at least the kids are getting their needs met and stuff like that. It's probably really hard for the kids, and they probably want to go back to their parents, but I think overall we wouldn't be doing this if we didn't think that it would be best for the kids to go to a place where they're going to be taken care of.","Therapist: ""Right, you're the immediate cause, kind of at the end of the whole process. But the true cause happened years or months before you got there, as people made decisions. that maybe weren't the best for their children, for themselves. So you're really coming in, to some extent, the tail end of a long series of behavioral choices.""
Patient: ""Yeah, that's true.""
Therapist: ""Ultimately, for this family that's causing you, that you're worried about? In kind of the, looking at it in a long-term lens, do you think the children are better off because they're not with that family right now?""",145.94,174.38
062_011,062,11,2,I guess not. It just feels like it is.,"Therapist: ""So immediately there's some pain because you have to break up the family, but in the long run, Maybe there's a better result.""
Patient: ""Yeah, yeah.""
Therapist: ""Even with that, though, let's talk about the concern you have about making a poor decision. So, based on what you're describing, do you believe this was actually a poor decision?""",203.93,207.13
062_013,062,13,1,"Yeah, yeah, I think so. And I'm not sure anybody else would have made a different decision either.","Therapist: ""Even with that, though, let's talk about the concern you have about making a poor decision. So, based on what you're describing, do you believe this was actually a poor decision?""
Patient: ""I guess not. It just feels like it is.""
Therapist: ""It feels like it is, and it was a tough decision. But looking at it in the weight of the evidence, maybe you can appreciate that you might have had to do the same thing even if you go back in time.""",221.71,227.11
062_015,062,15,2,"And you don't want to go through this again No, I mean not this feeling but I do want to keep doing my job But doing your job in a world where you could make a mistake that's not as appealing Yeah, I mean I guess I always knew I could make mistakes, but it just feels really real now I guess is the difference I","Therapist: ""It feels like it is, and it was a tough decision. But looking at it in the weight of the evidence, maybe you can appreciate that you might have had to do the same thing even if you go back in time.""
Patient: ""Yeah, yeah, I think so. And I'm not sure anybody else would have made a different decision either.""
Therapist: ""So you really did what you had to do. But because there's still a pain component there for them, you were feeling torn.""",242.65,269.3
062_017,062,17,4,I guess the biggest mistake you can really make is to miss some form of abuse or something like that.,"Therapist: ""So you really did what you had to do. But because there's still a pain component there for them, you were feeling torn.""
Patient: ""And you don't want to go through this again No, I mean not this feeling but I do want to keep doing my job But doing your job in a world where you could make a mistake that's not as appealing Yeah, I mean I guess I always knew I could make mistakes, but it just feels really real now I guess is the difference I""
Therapist: ""So in this particular instance, based on what you're saying, it doesn't seem like a mistake. Let's consider a situation where you did make a mistake. That would be the worst case, right? We're just taking things to the worst case scenario. Your fear here is that, in a sense, regardless of what already happened, going forward, you would be mortified to make an error. Because of this pain you're feeling right now. Unbearable. And it's thrown everything into chaos for you. So, looking around where you work and the history of your profession, what's a mistake you see people make from time to time that you would be frightened of?""",325.71,331.22
063_005,063,5,4,"Terrible. It would feel like, you know, I had a role in that kind of thing happening to somebody. Like it was, I'm partially to blame for somebody being harmed. And that is like the exact opposite of what my job is supposed to be.","Therapist: ""That's the type of mistake you're afraid of making.""
Patient: ""Yeah.""
Therapist: ""And what would that feel like to make that mistake?""",78.86,97.31
063_008,063,8,4,"I like to think that... I guess it's not possible to make that kind of mistake, but I think that that's naive. I think it is possible. Sure. And I would like to learn from that, but I don't know... what other people would do. Like, I don't know if I would lose my job or anything.","Patient: ""Terrible. It would feel like, you know, I had a role in that kind of thing happening to somebody. Like it was, I'm partially to blame for somebody being harmed. And that is like the exact opposite of what my job is supposed to be.""
Therapist: ""So that would be a worst-case outcome. You would be extremely upset. You're extremely upset now. Well, you're a 5 out of 10 right now, but you're an 8 when you're in bed in the morning. Yeah. Is it reasonable that a professional makes a mistake like that? This is a mistake of kind of missing something that normally would be caught. Is it reasonable that they continue on in the field and try to learn from that?""
Patient: ""I don't know. I mean...""",143.04,163.11
063_010,063,10,4,"I would be thinking, I don't know how this will ever be better. I don't know how I'm ever going to feel okay about what I did.","Patient: ""I don't know. I mean...""
Patient: ""I like to think that... I guess it's not possible to make that kind of mistake, but I think that that's naive. I think it is possible. Sure. And I would like to learn from that, but I don't know... what other people would do. Like, I don't know if I would lose my job or anything.""
Therapist: ""Right, there might be consequences for that type of error. It's not intentional. It's something that, like many mistakes, would happen due to a confluence of circumstances. You being tired, it being the end of the day, them not being honest. There's mitigation there. But still, I can appreciate you wouldn't want to make that mistake either way. What would your After making a mistake like that, what would your thought be? What would you be thinking?""",194.07,200.6
063_014,063,14,2,"I don't know, I mean... I guess ideally I would say to myself, it's gonna get better and, you know, this will pass and everything, but... I don't know, it's just hard.","Therapist: ""So by extension, I'll never feel okay about what I did.""
Patient: ""Yeah.""
Therapist: ""Yeah. And what do you think you would do then in terms of your reaction to that thought?""",219.46,233.83
063_016,063,16,4,"I think I would probably have to take some time off. I mean, it's just like, I would be so stressed afterwards. I'm worried I would make another mistake because I'm so stressed out and having trouble focusing.","Therapist: ""Yeah. And what do you think you would do then in terms of your reaction to that thought?""
Patient: ""I don't know, I mean... I guess ideally I would say to myself, it's gonna get better and, you know, this will pass and everything, but... I don't know, it's just hard.""
Therapist: ""What do you think it would do to your work performance?""",239.22,250.1
063_018,063,18,2,"Yeah. I mean, I guess I never thought about it like that, although that makes a lot of sense. Like, it... If I... If I just... calm down and try to let it go, then I'll do my job better and I won't have that risk as much, but if I keep feeling like this, I'm not focusing, and then I could make a bigger mistake because of it.","Therapist: ""What do you think it would do to your work performance?""
Patient: ""I think I would probably have to take some time off. I mean, it's just like, I would be so stressed afterwards. I'm worried I would make another mistake because I'm so stressed out and having trouble focusing.""
Therapist: ""So, in a strange way, the anxiety, the thoughts you're having now and the resulting anxiety are leaving you more at risk to make a mistake.""",263.39,287.62
064_004,064,4,2,"If I go to work, I'm going to make a mistake.","Therapist: ""Let's talk about this. Those type of thoughts, like I can't make a mistake or something like that, we call those automatic thoughts. We'll have plenty of time to talk about the different structures in CBT. I do want to explain it to you, but over the course of several sessions. Let's just take pieces of it for now.""
Patient: ""Okay.""
Therapist: ""So, what we believe is that your beliefs combine with the situation and create these thoughts. So you have this belief, so you're laying in bed before work, and you have this belief that you're maybe not competent, And then the situation that combines with that is it's time to go to work. So the stress of it being time to actually get up and get ready and go to work. And then you have an automatic thought in that moment. And right now it's one tied to dread and fear. Let's try to identify an exact one for this example. So let's use that scenario. You believe that you might not be competent. You're laying in bed and the alarm clock goes off. So you're kind of pressured to make a decision about, do I get ready for work or not? What's the thought right then?""",119.28,121.77
064_006,064,6,4,"So, I mean, what am I supposed to say to myself, I guess?","Therapist: ""So, what we believe is that your beliefs combine with the situation and create these thoughts. So you have this belief, so you're laying in bed before work, and you have this belief that you're maybe not competent, And then the situation that combines with that is it's time to go to work. So the stress of it being time to actually get up and get ready and go to work. And then you have an automatic thought in that moment. And right now it's one tied to dread and fear. Let's try to identify an exact one for this example. So let's use that scenario. You believe that you might not be competent. You're laying in bed and the alarm clock goes off. So you're kind of pressured to make a decision about, do I get ready for work or not? What's the thought right then?""
Patient: ""If I go to work, I'm going to make a mistake.""
Therapist: ""Going to make a mistake. So if I go, I'm going to make a mistake. And then we talked about your reactions, being late, worry, anxiety. So what we like to do when we identify an on-back thought like that is what's called self-talk. And at first this may seem a little odd, right? So you have this thought that comes through. It can be an image, too. A thought, image. But it's cognitive in nature. And I can't make a mistake. Or I'm going to make a mistake. I'm going to make a mistake. That's your thought. The self-talk this is like a rehearsed statement that you literally say to yourself Which again I get that seems a little odd the first time I do it so really you're talking to yourself but over time We believe if you can keep applying the self-talk strategy That you will eventually change the outcome and the reaction and change the underlying belief. Okay. At first, though, it's going to seem quite foreign to you. Tell me how you're processing this now, in terms of...""",208.8,212.55
064_008,064,8,2,"I guess I told myself I have to get to work on time because if I don't it's gonna be even worse if I make a mistake and I'm late then it just you know it compounds and I Guess I would tell myself it's gonna be okay. You just had to get through this day All right, so when you do that","Therapist: ""Going to make a mistake. So if I go, I'm going to make a mistake. And then we talked about your reactions, being late, worry, anxiety. So what we like to do when we identify an on-back thought like that is what's called self-talk. And at first this may seem a little odd, right? So you have this thought that comes through. It can be an image, too. A thought, image. But it's cognitive in nature. And I can't make a mistake. Or I'm going to make a mistake. I'm going to make a mistake. That's your thought. The self-talk this is like a rehearsed statement that you literally say to yourself Which again I get that seems a little odd the first time I do it so really you're talking to yourself but over time We believe if you can keep applying the self-talk strategy That you will eventually change the outcome and the reaction and change the underlying belief. Okay. At first, though, it's going to seem quite foreign to you. Tell me how you're processing this now, in terms of...""
Patient: ""So, I mean, what am I supposed to say to myself, I guess?""
Therapist: ""That's a good question. We'll work on that, and that's what we can do now. Okay. Let's take a look at some self-talk. some adaptive responses that we can build. So, I'm going to make a mistake. That's the automatic thought. That's directly leading, seems to be, to feelings of worry, dread, and physically not getting to work on time. Have there ever been times when you've had that thought and you went to work on time still? Yeah What was different about those times?""",258.35,282.25
065_001,065,1,2,"I don't know. I mean, I guess none technically. None that have been something I've gotten in trouble for or anything like that. Sometimes it's hard to tell because, you know, you don't always hear from people afterwards. You can't really tell was it a mistake or not. But I guess none that it had, like, any major consequences.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. How many times have you gone to work and made a mistake?""",34.2,51.37
065_011,065,11,2,"I guess, like, everybody makes mistakes?","Therapist: ""Probably not supported by the evidence.""
Patient: ""Yeah, I guess that's true.""
Therapist: ""So, the automatic thought is not accurate and not useful. It's got a couple strikes against it. But it is the thought you're having, so let's deal with it. I'm going to make a mistake. So what could you tell yourself as the first part of the adaptive response, which acknowledges that fear, that's realistic, that acknowledges that fear of making a mistake.""",117.45,121.44
065_013,065,13,1,"I'm a good caseworker, and I need to do my job so I can help other people, and it's going to be okay.","Therapist: ""So, the automatic thought is not accurate and not useful. It's got a couple strikes against it. But it is the thought you're having, so let's deal with it. I'm going to make a mistake. So what could you tell yourself as the first part of the adaptive response, which acknowledges that fear, that's realistic, that acknowledges that fear of making a mistake.""
Patient: ""I guess, like, everybody makes mistakes?""
Therapist: ""Everybody makes mistakes. I could make a mistake today, but it's unlikely. Would that also be accurate? Yeah. So, everybody makes mistakes. I could make a mistake, but it's probably not going to happen, rather than I'm going to make a mistake. So you're going to have that automatic thought either way, likely for a while, until you start to apply these adaptive responses. So this is what we're working on, is your response. So everybody makes mistakes. I could make a mistake. Probably not going to happen. And what could be the next part, which is realistic but also positive, that can help get you past the reaction of being late and worrying?""",167.9,174.58
065_015,065,15,2,"I mean, it feels a little better. It's hard to, you know, I still feel like it's dangerous. I might make a mistake, but I guess it helps a little bit.","Therapist: ""Everybody makes mistakes. I could make a mistake today, but it's unlikely. Would that also be accurate? Yeah. So, everybody makes mistakes. I could make a mistake, but it's probably not going to happen, rather than I'm going to make a mistake. So you're going to have that automatic thought either way, likely for a while, until you start to apply these adaptive responses. So this is what we're working on, is your response. So everybody makes mistakes. I could make a mistake. Probably not going to happen. And what could be the next part, which is realistic but also positive, that can help get you past the reaction of being late and worrying?""
Patient: ""I'm a good caseworker, and I need to do my job so I can help other people, and it's going to be okay.""
Therapist: ""Okay, so there's a few elements in there. It's going to be okay. I need to do my job. I help people. All those are true. Right? So applying, even as you say this here with me, as you say, it's going to be okay, I need to do my job. What reaction are you having right now?""",195.71,207.67
065_017,065,17,2,"Yeah, I think I probably will because now it'll be hard to have those thoughts and not think of you and think, okay, I need to calm myself down a little bit because we've been talking about it for so long.","Therapist: ""Okay, so there's a few elements in there. It's going to be okay. I need to do my job. I help people. All those are true. Right? So applying, even as you say this here with me, as you say, it's going to be okay, I need to do my job. What reaction are you having right now?""
Patient: ""I mean, it feels a little better. It's hard to, you know, I still feel like it's dangerous. I might make a mistake, but I guess it helps a little bit.""
Therapist: ""Can you see yourself being able to, in the moment, and I realize... This is difficult, but in the moment of having that automatic thought, having that worry come in, can you see yourself applying this self-talk?""",223.38,235.3
065_019,065,19,1,"Yep, that's true. And it did help in the past, so...","Therapist: ""Can you see yourself being able to, in the moment, and I realize... This is difficult, but in the moment of having that automatic thought, having that worry come in, can you see yourself applying this self-talk?""
Patient: ""Yeah, I think I probably will because now it'll be hard to have those thoughts and not think of you and think, okay, I need to calm myself down a little bit because we've been talking about it for so long.""
Therapist: ""And you've already used self-talk on your own before you even knew about these strategies.""",240.48,243.77
065_021,065,21,2,Yeah. It's not going to work every time. Okay.,"Therapist: ""And you've already used self-talk on your own before you even knew about these strategies.""
Patient: ""Yep, that's true. And it did help in the past, so...""
Therapist: ""A lot of the, or I should say some of the effectiveness of this is based on your ability in that moment to take a step back and follow the training. Just like many professionals, professionals depend on their training to help them make the correct intervention, correct decision. So think of this kind of like, something you've learned in a training. This is a self-talk. It's prepackaged. It's ready to go. You can even have it written down. It doesn't have to be short. It can be like a paragraph or more if you wanted. And it's a matter of following the protocol. So you have the automatic thought. It's easy to descend into worry and fear. You're just looking to grab a moment in there and apply this treatment, this strategy. Does that make sense? Sometimes, it's likely. Well, most of the time I think you would be able to do this. Sometimes you probably won't. And it's important in those moments to not get discouraged. Right? So you can have a self-talk for that too. Okay. Right? Something like, Dr. Grani said it was likely that once in a while I wouldn't be able to do this.""",333.4,337.7
065_023,065,23,1,"Yeah, that makes a lot of sense.","Therapist: ""A lot of the, or I should say some of the effectiveness of this is based on your ability in that moment to take a step back and follow the training. Just like many professionals, professionals depend on their training to help them make the correct intervention, correct decision. So think of this kind of like, something you've learned in a training. This is a self-talk. It's prepackaged. It's ready to go. You can even have it written down. It doesn't have to be short. It can be like a paragraph or more if you wanted. And it's a matter of following the protocol. So you have the automatic thought. It's easy to descend into worry and fear. You're just looking to grab a moment in there and apply this treatment, this strategy. Does that make sense? Sometimes, it's likely. Well, most of the time I think you would be able to do this. Sometimes you probably won't. And it's important in those moments to not get discouraged. Right? So you can have a self-talk for that too. Okay. Right? Something like, Dr. Grani said it was likely that once in a while I wouldn't be able to do this.""
Patient: ""Yeah. It's not going to work every time. Okay.""
Therapist: ""Does that make sense?""",338.79,340.95
065_027,065,27,2,"That makes sense, because if you could just flip a switch, I would only have to have one therapy session.","Therapist: ""So it's the chaos of life, right, and the chaos of emotions that sometimes interfere. The more times you have success, that seems to be tied with a better chance of improving and reduction of symptoms. But allow yourself failures as well. It's what I would expect. from anybody trying to untangle all these feelings and thoughts. There's not going to be a perfect connection between an automatic thought and applied self-talk.""
Patient: ""Yeah.""
Therapist: ""Okay. So be easy on yourself as you try this.""",379.12,384.98
066_001,066,1,4,I think it's probably closer to a three now. Feeling more hopeful. And kind of not feeling... I guess maybe feeling like it's a little bit less of a big deal than I felt like when I came in.,"Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So now as you kind of take an emotional inventory of your stress and worry and anxiety and you scale it, where would you put yourself now?""",40.65,52.97
066_007,066,7,3,"Yeah, I think that'll be good because then also in the morning I'll remember, it's the morning, I'm having these thoughts, I need to do this.","Therapist: ""It's still there. Three is still suffering. But not as much as before. And not nearly as much as at the peak.""
Patient: ""Yeah, yeah.""
Therapist: ""Do you think going forward you can apply this self-talk in the morning when that amat thought comes up? Like, can we make that kind of a plan?""",90.6,97.39
066_011,066,11,2,Okay. What should I do with it? Should I write it on a sticky note and get rid of it? Should I keep it in a journal?,"Therapist: ""There are a lot of places we're going to go as we talk about CBT and how it relates to What you're going through and I don't want to put too much on you at one time So I'm kind of deliberately Not going to a long explanation the theory and not assigning a lot of homework but homework is an important part of it, okay and one that I feel is in the best interest of clients to really take seriously and make a best effort to do. Okay. So, I'd like that to be one of the, you know, if you're okay with it, that'd be one of the homework steps. And the other one, so it'd just be two things for this week. Okay. So that, self-talk. Okay. In the morning. And the other one was, is really just starting to cultivate an awareness in the day of when you're having these automatic thoughts. Okay. These automatic thoughts precede feelings and behaviors that you don't like, like feeling worried. So they're a little hard to pick up at first, because you're already having the feeling before you even think to think about the thought, if that makes sense. I know there's a few steps in there, but you're already having the feeling of worry, and now I'm asking you to stop in that moment and try to recover the thought that led to that. Yeah. That's not an easy request. So that's why I'm starting out with just trying to bring up an awareness of that. If you can, I think this would be very helpful, the best way is to write it down. If it's safe to do so and you can't.""
Patient: ""Okay.""
Therapist: ""So perhaps sometime in the day you find yourself extra worried and then you think back to what was going through your mind and you find it was Worrying about the welfare of that family. Like a thought, like, oh, they're not doing so well. Just don't judge the thought. Just write it down. I was thinking the family might not be doing so well.""",232.34,237.29
066_025,066,25,1,"No, I mean, I think it was really helpful. I just had to remember to, you know, kind of combat things in the morning, and then as the day goes by, if I notice any other thoughts, just write them down and everything. I can do that.","Therapist: ""Does that make sense?""
Patient: ""Mm-hmm.""
Therapist: ""Do you have any questions about or concerns about today and kind of what we talked about?""",270.4,287.78
066_027,066,27,2,"Yeah, I mean, I think, you know, I work a lot to help other people, so I think I probably do have the ability to help myself as well. And I also believe that, you know, if I do the work, then in the future when stuff makes me stressed out, I might be a little better at handling it, so... Yeah, so I hope that you'll be able to overcome","Therapist: ""Do you have any questions about or concerns about today and kind of what we talked about?""
Patient: ""No, I mean, I think it was really helpful. I just had to remember to, you know, kind of combat things in the morning, and then as the day goes by, if I notice any other thoughts, just write them down and everything. I can do that.""
Therapist: ""All right. I think that would be a great start. And we'll set up a time when we're done here for another appointment for next week. We'll get that all situated. But I want to close just by letting you know kind of my impressions from this first session. I know you have worries, and I am working on understanding them with the family and the decision you made, and I can certainly appreciate it's a struggle for you. At the same time, I see somebody very conscientious. I know you're very concerned about the work you do. You're concerned about the people you interact with. Compassionate, empathetic. I see a lot of strength in terms of your ability to understand these concepts I'm talking about and apply them in your life. So I want you to take away from this, I hope you take away from this, that you should be hopeful. I feel like you have a lot of positive characteristics and strengths that you can bring to overcome this struggle, and I think you'll be stronger as a result of working to overcome it. Does that resonate with how you think of yourself?""",372.91,395.27
067_005,067,5,3,"Yeah. So, a couple weeks before I came in to see you, what happened was our car was stolen out of our driveway, and it was just awful for my family. We had... There was stuff in the car that was stolen. My wallet was in there. Um, what happened was someone walked into our house. We live in a really good neighborhood, so, um, we leave, like, us and some of our neighbors leave our doors unlocked sometimes, um, because we don't think that anything like that could happen to us. And, um, so someone came in and stole our car keys, where we typically kept them, and stole our car out of our driveway, um, when we weren't there. That's awful.","Therapist: ""I'd like to talk more about that today, if that works. Also, I want to kind of evaluate some of the evidence behind the fears. So when you talk about it, we'll kind of pick up on some of the evidence and we'll just critically look at that, this part we do today, if that makes sense. Sure. And then toward the end, we'll work on some strategies to help you feel better. I know this is bothering you. Does that sound like a good plan?""
Patient: ""Yeah.""
Therapist: ""All right. So, tell me more about... It was a... It started with a car that got stolen?""",101.47,147.23
067_011,067,11,3,Yeah. Wow. It was really scary.,"Therapist: ""And just took the keys?""
Patient: ""Yeah.""
Therapist: ""Stole your car?""",155.72,158.97
067_013,067,13,2,"Right when we were out with my family and right when we got home, we saw that the car wasn't there, and of course I'm panicking, and we called to our neighbors and see if they stole anything, and then we called the police. Yeah.","Therapist: ""Stole your car?""
Patient: ""Yeah. Wow. It was really scary.""
Therapist: ""It would be scary. Did you report this to the police?""",163.83,176.55
067_015,067,15,1,"They, yeah, they actually, uh, we do have our car back now. Um, the cops found it. Apparently, um, it was, uh, uh, one of my son's friends. He, they live down the street. Um, apparently, um, some of these kids just walked in, um, took our car, and then they, they ended up admitting to it later when their parents... found out what they did, and they knew that it was our car, they told them to go to the police and, you know, confess to what happened.","Therapist: ""It would be scary. Did you report this to the police?""
Patient: ""Right when we were out with my family and right when we got home, we saw that the car wasn't there, and of course I'm panicking, and we called to our neighbors and see if they stole anything, and then we called the police. Yeah.""
Therapist: ""Alright, and did they catch the person or get your car back or anything?""",183.32,214.51
067_019,067,19,1,Right. Yeah.,"Therapist: ""Uh, so, so they caught them.""
Patient: ""Yeah.""
Therapist: ""And, uh, you got your, your car back.""",222.24,224.38
067_021,067,21,4,"Yeah, and it was really an inconvenience because my wallet was in the car, so right away, you know, like, bank accounts, I'm calling banks to block my card, I'm, like, wondering. You know, trying to remember if my social security card was in my wallet. And I'm just trying to go through all the steps to make sure, you know, it's the holidays, that they're not taking all of our money and stuff like that, because I didn't know who had the car, so I'm trying to put a stop to all that.","Therapist: ""And, uh, you got your, your car back.""
Patient: ""Right. Yeah.""
Therapist: ""Still, though, scary experience.""",226.96,254.06
067_025,067,25,4,Exactly. It was really exhausting.,"Therapist: ""So, frightening, but also a lot of work.""
Patient: ""Yeah.""
Therapist: ""A lot of scrambling to try to cover all the bases.""",261.77,263.98
067_027,067,27,4,"Yeah, it's... I feel like I'm afraid all the time, and it's really affecting my life, because I'm always worried, is someone going to come back into our house again? Is someone going to take my car again? When they took my car, did they make copies of the car keys? So, I'm at work, and I always have to park where I can see my car, so that if something happened, I would know, which is really inconvenient, and my boss is starting to notice, because I'm always getting up from my desk to check for my car, to make sure it's still there, because if I don't, I'm really anxious, I'm really uncomfortable. Same thing, you know, if we go out to eat, I'm always parking, you know, by a window, so I can see my car. Because I'm really worried that they couldn't get my car. Maybe they made copies of the keys. And I'm also worried that people can come into my house at any time and take things. I've been really worried about that to the point that I'm starting to not want to leave my house. My husband's starting to notice because I'm not wanting to go out like we typically do. I'm not wanting to, like, go to dinner or anything like that because I'm worried if I'm not home, then someone's going to walk in and take my things.","Therapist: ""A lot of scrambling to try to cover all the bases.""
Patient: ""Exactly. It was really exhausting.""
Therapist: ""So now that you have the car back... and you've taken care of all those things, which indicate last time some things are still bothering you.""",275.17,355.1
068_001,068,1,2,"Yeah, I just feel very violated. Like, it could happen again. It may be something worse. You know, like a more serious criminal or something like that.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. All right, so beyond the theft of your car, now you have a few other consequences that seem to have crept in, worried at work that somebody's going to steal the car again. except from work this time, and also worried somebody's going to come in the house.""",48.71,59.63
068_003,068,3,4,"Yeah, well, it wasn't open. It was just unlocked. Like, we left our door unlocked. So we've started to make sure our door's locked. But even with that, sometimes what I do is, like, I'll obsessively almost, like, check. Like, I'll be worried when I leave and I'll have to come back sometimes. Like, did I really lock the door? I'm not sure. And my husband's trying to tell me. Yes, he locked the door, but I still worry to make sure that it's locked.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. All right, so beyond the theft of your car, now you have a few other consequences that seem to have crept in, worried at work that somebody's going to steal the car again. except from work this time, and also worried somebody's going to come in the house.""
Patient: ""Yeah, I just feel very violated. Like, it could happen again. It may be something worse. You know, like a more serious criminal or something like that.""
Therapist: ""Sure. I mean, there's always that possibility. Have you done anything to secure the house? Like you said, the door was open before.""",68.34,98.42
068_013,068,13,4,"Yeah. I feel like I'm worried too much, almost like consumed by it.","Therapist: ""Closed bank accounts and credit cards.""
Patient: ""Yes.""
Therapist: ""Right. So, it's understandable you'd have this fear. From what you're saying, though, it's kind of interfering with work a little bit and maybe with your relationship with your husband.""",143.0,146.48
068_015,068,15,2,"Yes. Yeah, and it's really hard, for example, to enjoy myself when I'm going out because I'm constantly worrying, did I lock the door? Or is someone going to break in? Or do people, when they were in my house, make keys? So overall, I just can't enjoy myself that much anymore because I'm consumed by this worry of what could happen if I'm not home.","Therapist: ""Right. So, it's understandable you'd have this fear. From what you're saying, though, it's kind of interfering with work a little bit and maybe with your relationship with your husband.""
Patient: ""Yeah. I feel like I'm worried too much, almost like consumed by it.""
Therapist: ""So it's what you're thinking about most of the time?""",151.21,176.31
068_021,068,21,1,"No, this is the first time that something like that has happened to me. Like I said, we live in a really safe development. Never really had to worry about this.","Therapist: ""Through all this. So this happened not too long ago?""
Patient: ""Right, about a month ago.""
Therapist: ""About a month ago. Has anything ever happened like this before where you had something taken or something occur similar to that and you've had all these fears associated with it?""",199.35,207.73
068_029,068,29,4,"Well, so right then, it was more panic. Like, like something had just happened, and I was panicking, like, what exactly was in the car, and we have to call the cops, and all these steps that I needed to take. So it was more intense, maybe, right after. Now it's just, like, this long-lasting, like, If I don't go home and check, then my anxiety is higher. Or if I don't see my car, my anxiety is higher.","Therapist: ""And did this kind of sense of vulnerability, dread, did it start right after the car was stolen?""
Patient: ""Yes. Yeah.""
Therapist: ""How's it progressed now? from then till now? Better, a little worse, the same?""",238.72,269.51
068_033,068,33,4,"And it's, like, really lasting. Like, I can't seem to shake it unless I do something, like go check or call my neighbor and make sure my door is closed or something like that. And then I'll feel better for a little while, but then it comes back.","Therapist: ""All right. So it's this anxiety a lot of the time.""
Patient: ""Yeah.""
Therapist: ""Throughout your work day and at home.""",280.84,297.82
069_001,069,1,1,"Yes. There was at least one or two times where I had to be on a meeting on the phone, so it would have just been extremely noticeable and inconvenient if I were to say, hold on a minute, you know, during this meeting while I went to go check for my car. So there were times when I was occupied that I couldn't go and then didn't think about it for a minute afterwards because I was kind of distracted.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Has there ever been a moment, say in the last few weeks, when you wanted to get up and check to see if your car was okay or there, and you just couldn't because you had something to do or the phone was ringing?""",41.69,70.04
069_005,069,5,2,"I guess I was thinking that I needed the reassurance that my car was there. And if I don't go, then, you know, no one will be watching and someone can take it. Like, someone has to make sure that the car is there so that it's secure. And I guess I thought if at least it wasn't there, then I could call and do whatever I needed to do, but I feel like I needed the reassurance that it was there.","Therapist: ""Okay, so being distracted... prevented you from, or helped, kind of put your mind in another place temporarily.""
Patient: ""Right.""
Therapist: ""What was, when you were, when you first had that desire to go look at the car, you felt that need. Yeah. And you realized you couldn't because the meeting was starting or whatever was happening. What was going through your mind right then?""",103.4,130.21
069_007,069,7,2,"That I was safe, that my stuff was safe.","Therapist: ""What was, when you were, when you first had that desire to go look at the car, you felt that need. Yeah. And you realized you couldn't because the meeting was starting or whatever was happening. What was going through your mind right then?""
Patient: ""I guess I was thinking that I needed the reassurance that my car was there. And if I don't go, then, you know, no one will be watching and someone can take it. Like, someone has to make sure that the car is there so that it's secure. And I guess I thought if at least it wasn't there, then I could call and do whatever I needed to do, but I feel like I needed the reassurance that it was there.""
Therapist: ""You needed the reassurance.""",131.31,133.53
069_009,069,9,1,"Oh, yeah. I don't leave hardly anything. Like, I, as soon as we, you know, go shopping, like, there's hardly anything in the car anymore. I have to bring it all inside.","Therapist: ""You needed the reassurance.""
Patient: ""That I was safe, that my stuff was safe.""
Therapist: ""Have you noticed yourself bringing more on your person, like, from the car, like, not leaving stuff in the car?""",141.6,151.3
069_011,069,11,2,"I, even I would say, like, even before I park somewhere, like, in selecting a parking space, like I was saying, I kind of, like, I have to choose a good parking space to make sure I can get to my car if I need to in a hurry, or that I can bring stuff in with me, and then, you know, I always bring a bag of stuff with me, like, into wherever I'm going, which, as you can imagine, is a pain.","Therapist: ""Have you noticed yourself bringing more on your person, like, from the car, like, not leaving stuff in the car?""
Patient: ""Oh, yeah. I don't leave hardly anything. Like, I, as soon as we, you know, go shopping, like, there's hardly anything in the car anymore. I have to bring it all inside.""
Therapist: ""And is that thought come to you, like, right as you park somewhere? Do you have a thought?""",159.01,181.34
069_017,069,17,4,"I don't know. I feel anxious just thinking about that, that that could happen, that that's a possibility. I really feel anxious right now. I guess if they didn't recover the car, I mean, like I said, I would cancel my cards or whatever was in the car, and eventually we'd, you know, find a new car, I guess, and kind of move on from there.","Therapist: ""You're making that decision each time and loading a bag up. So, yeah, I could imagine that would be inconvenient.""
Patient: ""Yeah.""
Therapist: ""And time-consuming. Yes, very. All right. So a lot of this seems to be based on... this fear of loss. Let's look at what would happen if they never recovered the car.""",224.66,249.43
069_019,069,19,1,"Eventually, I think, yeah, we would buy another one. We have pretty good insurance, so they would probably at least cover, you know, The car, what we owe, if we had a total order, whatever.","Therapist: ""And time-consuming. Yes, very. All right. So a lot of this seems to be based on... this fear of loss. Let's look at what would happen if they never recovered the car.""
Patient: ""I don't know. I feel anxious just thinking about that, that that could happen, that that's a possibility. I really feel anxious right now. I guess if they didn't recover the car, I mean, like I said, I would cancel my cards or whatever was in the car, and eventually we'd, you know, find a new car, I guess, and kind of move on from there.""
Therapist: ""So it would certainly be more inconvenient to lose the entire car. But you would probably buy another one.""",261.18,275.86
069_023,069,23,2,Maybe like a 6 or a 7.,"Therapist: ""So, as far as the car is concerned, really the worst case, and I know this creates some anxiety even just talking about this, the worst case is that you lose it altogether and get another car.""
Patient: ""Right.""
Therapist: ""Yeah. So, let's take a moment here. Because you brought that up with the anxiety, I'm glad you felt comfortable enough to mention that to me here in the moment. When we look at this particular anxiety, which is somewhat new to you, if you were to rate it from 1 to 10, so 1 is really not bothering you at all, right? And 10 is the worst anxiety you've ever experienced about anything, not just the fear of losing a car or somebody coming to your house, but like anything in your life. Where is this anxiety rank right now?""",333.66,337.22
069_027,069,27,2,"Just like mentioning like what would happen when you mentioned like what would happen if, you know, 6 or 7. 6 or 7. Yeah. Alright.","Therapist: ""Alright, so fairly intense.""
Patient: ""Yeah.""
Therapist: ""How's your feeling right now, right here?""",342.51,352.39
069_029,069,29,3,"Since the event started, I mean. It was probably, like, a 10, like, when it happened. Like, very intense. Normally, I would say it's moderately, like, around a 5, like, throughout the day. Like, a 4 or a 5. Like, I'm pretty, like, I have this level of anxiety that I just can't shake. Like, I don't think I'm ever fully just not worrying about it. Like, it's always there.","Therapist: ""How's your feeling right now, right here?""
Patient: ""Just like mentioning like what would happen when you mentioned like what would happen if, you know, 6 or 7. 6 or 7. Yeah. Alright.""
Therapist: ""And that has been mostly unchanged since this started?""",359.65,385.53
069_031,069,31,4,"Yeah. Not lately, which is, again, creating problems in my marriage, in my family, at my work, the fact that I always have this worry and I can't relax.","Therapist: ""And that has been mostly unchanged since this started?""
Patient: ""Since the event started, I mean. It was probably, like, a 10, like, when it happened. Like, very intense. Normally, I would say it's moderately, like, around a 5, like, throughout the day. Like, a 4 or a 5. Like, I'm pretty, like, I have this level of anxiety that I just can't shake. Like, I don't think I'm ever fully just not worrying about it. Like, it's always there.""
Therapist: ""So there's not many points that are below a 4.""",389.11,401.02
070_001,070,1,1,"I mean, it would be hard for sure to, as I said, to kind of get through that with my family. But I think my family will get past it. Like I said, we have good insurance. My husband has a really good job, so I feel like we would get past it eventually.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. One of the ways we look to defeat anxiety is to be okay with the worst case scenario. That's not always easy. It's easy for me to say. It's not always easy to do. Do you think you could ever be, and nobody wants their car stolen, but do you think you could ever be comfortable with the idea that you may have to replace that car at some point?""",55.67,74.86
070_005,070,5,2,"That it would be awful, that we wouldn't be able to afford a new car, and we would have one car for my family.","Therapist: ""Alright, so what you're describing there, as you talk about when you have recently good insurance, and your husband works, and you work, that's an adaptive response. So that's, let's call that self-talk.""
Patient: ""Okay.""
Therapist: ""That's a message that you give to yourself, that you say to yourself, that tends to reduce anxiety, it tends to go after what we call the automatic thought, which is the thought that comes up that leads to worry. So for example, when I said to you, what would happen if your car was stolen, what was the first thought that came to your mind right at that moment?""",121.67,128.88
070_009,070,9,5,"I was, I noticed, you know, sad, like feeling depressed, like this is awful. Also really angry, like that someone would do this to me, like who does that? You know, that someone would take my car, that someone would do that kind of thing.","Therapist: ""Alright. So, it would be awful. Yeah. We'd only have one car for the whole family. Yeah. Couldn't afford to replace it. Right. So, kind of, you know, so those three, three thoughts right there in quick succession.""
Patient: ""Right.""
Therapist: ""From hearing that, you know, talking about the scenario where your car's stolen. And what emotions did you immediately notice when those thoughts were in your mind?""",159.38,175.16
070_013,070,13,2,"Well, I could say, you know, not maybe, I could say maybe, well, you know, with the help of insurance and, you know, we have decent credit that I could, even if I can't afford, like, a perfect replacement or whatever, that we would be able to afford another car.","Therapist: ""So sad and angry.""
Patient: ""Yeah.""
Therapist: ""So moving back to that self-talk, That self-talk is designed to go after those thoughts, like the type of thoughts you just told me about, and to intervene before you have that reaction, the sadness and the anger. At first, when you use the self-talk, it's not going to work really well. It's something you have to keep applying over and over and over. Okay. likely work a little, and it'll likely become more effective the longer you can challenge those thoughts. Okay. So, let's break those earlier thoughts down, the ones you talked about when I mentioned that your car could be stolen. Okay. Specifically, one was you wouldn't be able to replacement. Yeah. So, I think you've already touched on this from what you said, but what could your self-talk be specifically for, I can't afford to replace the car?""",248.44,267.02
070_015,070,15,2,Yeah.,"Therapist: ""So moving back to that self-talk, That self-talk is designed to go after those thoughts, like the type of thoughts you just told me about, and to intervene before you have that reaction, the sadness and the anger. At first, when you use the self-talk, it's not going to work really well. It's something you have to keep applying over and over and over. Okay. likely work a little, and it'll likely become more effective the longer you can challenge those thoughts. Okay. So, let's break those earlier thoughts down, the ones you talked about when I mentioned that your car could be stolen. Okay. Specifically, one was you wouldn't be able to replacement. Yeah. So, I think you've already touched on this from what you said, but what could your self-talk be specifically for, I can't afford to replace the car?""
Patient: ""Well, I could say, you know, not maybe, I could say maybe, well, you know, with the help of insurance and, you know, we have decent credit that I could, even if I can't afford, like, a perfect replacement or whatever, that we would be able to afford another car.""
Therapist: ""So the adaptive response there to that thought of we're not going to afford this could be this is going to be inconvenient, but it's likely that we would get insurance money to cover that. And we have good credit.""",288.09,290.21
070_017,070,17,1,"Yeah, I think so. I think that's likely that that would be the actual result.","Therapist: ""So the adaptive response there to that thought of we're not going to afford this could be this is going to be inconvenient, but it's likely that we would get insurance money to cover that. And we have good credit.""
Patient: ""Yeah.""
Therapist: ""So does that seem like a reasonable... Self-talk? Does that seem accurate?""",300.25,306.82
070_019,070,19,1,"Like right now, I think that, you know, I'm kind of calmed down and we're kind of working through it. I feel like I believe it, like I'm confident that that would happen. I think in the moment I might be not so sure. When my anxiety is a little bit higher, I think it would be harder to believe myself.","Therapist: ""So does that seem like a reasonable... Self-talk? Does that seem accurate?""
Patient: ""Yeah, I think so. I think that's likely that that would be the actual result.""
Therapist: ""Right. So in terms of, and we do this a lot in CBT, in terms of how much you believe a statement, right, so in terms of percent, how much do you believe right now that self-talk, that your insurance would cover the cost of replacing your car and you have good credit so you could replace that car?""",328.44,348.7
070_021,070,21,1,As I would when we're calmly working through solutions.,"Therapist: ""Right. So in terms of, and we do this a lot in CBT, in terms of how much you believe a statement, right, so in terms of percent, how much do you believe right now that self-talk, that your insurance would cover the cost of replacing your car and you have good credit so you could replace that car?""
Patient: ""Like right now, I think that, you know, I'm kind of calmed down and we're kind of working through it. I feel like I believe it, like I'm confident that that would happen. I think in the moment I might be not so sure. When my anxiety is a little bit higher, I think it would be harder to believe myself.""
Therapist: ""So in that moment with strong emotion and worry, you could say the thought, Like you could say it to yourself, but you're not going to believe it as much.""",363.4,366.76
071_001,071,1,1,"Yeah, and I think, like you said, that was really, you made a really good point when you said, like, about practicing. I think, like, the more that I said that to myself and reminded myself, you know, before maybe, like you mentioned that earlier, maybe, like, before I got to that point where I'm very intensely worried, I think, like, maybe when the thing, the thought first pops into my head, if I told myself that then I think it would have more of an impact than later on.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Well, that's understandable, and I would be inclined to think that you're probably correct there, that when your anxiety is high, that self-talk won't work quite as well because that emotion is in there. Right. it's interfering in this example. However, it probably still would work somewhat.""",50.18,78.27
071_021,071,21,4,"Yeah. Okay, so it was... like a week, week and a half ago, my family went over to my parents for dinner. And we were enjoying ourselves, like it was almost, you know, back to normal. I was kind of like somewhat relaxed and we were having a good time. And then when people started to leave and I wasn't so occupied, I just noticed like I started to feel anxious, like I started to notice. And then the kind of like the worry crept in and I was like really anxious, like when are we going? Like, we need to get back to the house. But I noticed that, like, I just felt really uncomfortable. Like, that's what I noticed at first. Like, I felt really uncomfortable. I felt really rushed. Like, we had to get out of there. And I just, I wasn't enjoying myself. Like, my anxiety, everything was kind of, like, heightened.","Therapist: ""But there's probably points where you're somewhat anxious, and then you get really anxious.""
Patient: ""Right.""
Therapist: ""So let's practice with another one of those. So think of a time, you know, since the incident, since the theft of the car, where you were kind of okay, more or less, like maybe a little anxious, and then your mood just quickly deteriorated.""",241.12,293.9
071_027,071,27,2,"Um, I think what I was thinking in the moment was like, we've been gone too long. And the fact that we, Been gone too long means that the house was left unattended because all my family was with me. So, while we were gone, someone took something from our house.","Therapist: ""Okay. It's like a pressure to just get out of there.""
Patient: ""Yes. Right.""
Therapist: ""So if you had to, and I know sometimes thoughts are kind of, you know, written out in language, but sometimes they're also kind of images in your mind. What do you think the thought was that preceded those series of emotions?""",322.68,339.51
071_033,071,33,3,Yeah. All right.,"Therapist: ""And in that time, somebody's burglarized our home. Yeah. So, that thought is certainly distressing. The part that stands out is that somebody's in your house.""
Patient: ""Yeah, exactly.""
Therapist: ""You're kind of minding your own business, going about enjoying yourself, and there's this intrusive thought of, somebody's in my house.""",369.14,371.31
072_009,072,9,2,Like what happened right before I felt that way.,"Therapist: ""What caused the feeling, exactly. So that's really, in my opinion, that's really the hardest part of this process.""
Patient: ""Yeah.""
Therapist: ""Is kind of exploring those feelings and then really working to connect what was I thinking right as that happened.""",69.96,72.25
072_011,072,11,2,"I think that's a really good point. Sometimes I don't know what you call the automatic thought. Sometimes I don't know that, but I can identify I'm feeling some sort of way. But like you said, when I really think about it, what happened right before that, I can kind of identify what caused that feeling. but I don't necessarily notice it right away.","Therapist: ""Is kind of exploring those feelings and then really working to connect what was I thinking right as that happened.""
Patient: ""Like what happened right before I felt that way.""
Therapist: ""And you were able to do that just here.""",78.07,98.06
072_023,072,23,2,"I think maybe right in the moment, like right after I have the thought, it's pretty high. Mm-hmm. And I think it kind of tapers from there, so like maybe like 80%. And then sometimes like, you know, with my husband there or maybe with myself when I've calmed down, you know, I can say, okay, well, I mean, the chances of this happening again, you know, and I kind of, like you said, can talk to myself and say, okay, well, the chances of us getting robbed like two times in rapid succession maybe are not that high.","Therapist: ""And at some point, probably in the next session or maybe one after that, we'll look at some different homework devices that you can use to, like records that you can use to capture those thoughts. Okay. As a way of not losing that throughout the day because you have that emotion, you have that thought. If you don't write it down, it's hard to remember what that was. Now we can probably start there with just having you write it down for now as it happens, and I'll get into the more formal thought record and everything a little later on. But I want to make sure I stay with what we started with here, which is this process. So we have the feeling, and that's fairly easy to identify. You seem like you're well connected to that. And the thought, which... All of us, it takes a little work to get that, but you did very well there. You got that thought. And now let's take a look at how we respond to that thought. So let's go back to that situation with your family. Okay. All right. So you're having fun, but that ends. The anxiety increases.""
Patient: ""Yeah.""
Therapist: ""And the thought is, there's someone in my house. Mm-hmm. Which, again, makes sense because someone was in your house and then eventually took your car. What can you, in terms of evaluation, what would you assign at that moment, in terms of how much you believe that thought? So we talked about how much you believe the response before, another response. What percent of you, your mind, believes that thought, that someone's in your house?""",234.5,268.46
072_031,072,31,1,"Well, I think it started maybe with my husband saying, like, you know, April, there is no one in the house. Like, wait. He's reassuring me that, like, we locked our door. So I think it started maybe with him saying, you know, what you would call, like, an adaptive response to kind of, like, try to calm me down when I was unable to do it myself. And then I'm like, okay, well, you know, you're right, we did. He reminds me, like, you did lock the doors or he locked the doors. And then I start to remember that myself and kind of calm me, like, calm myself down.","Therapist: ""And it makes sense that that would be scary.""
Patient: ""Yeah.""
Therapist: ""But then it starts to subside. Right. And it sounds like you're already applying, maybe without even knowing it, you're already applying self-talk, or you did.""",292.75,325.08
072_033,072,33,2,"Like, when I'm too anxious to think about it myself, and then I start to kind of do it myself.","Therapist: ""But then it starts to subside. Right. And it sounds like you're already applying, maybe without even knowing it, you're already applying self-talk, or you did.""
Patient: ""Well, I think it started maybe with my husband saying, like, you know, April, there is no one in the house. Like, wait. He's reassuring me that, like, we locked our door. So I think it started maybe with him saying, you know, what you would call, like, an adaptive response to kind of, like, try to calm me down when I was unable to do it myself. And then I'm like, okay, well, you know, you're right, we did. He reminds me, like, you did lock the doors or he locked the doors. And then I start to remember that myself and kind of calm me, like, calm myself down.""
Therapist: ""Alright, so he's giving you adaptive response ideas.""",330.89,337.02
073_003,073,3,2,"I guess I could say that I guess I could say that I'm pretty confident that we locked the door and, you know, that the house is secure so that there's no one in the house. But, you know, if there was, maybe, if that did happen, that we would handle it just like we did with the first time.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. So as we sit here now and you think about crafting an adaptive response for when, you know, maybe this thought returns, right? So oftentimes these automatic thoughts kind of cycle and you see the same one over and over, right? So my guess is that as other places you've gone, you've had that same or similar thought.""
Patient: ""Yes.""
Therapist: ""What adaptive response could we create together that could attack that automatic thought?""",64.37,91.7
073_013,073,13,3,I think I'm fairly confident.,"Therapist: ""How much do you believe that adaptive response?""
Patient: ""Now?""
Therapist: ""Mm-hmm.""",121.81,124.31
073_015,073,15,2,"That that's true, yeah. Like, I think that would be a likely outcome, that that You know, that we would be okay if it happened. You know, that it would really stink, but that we could get through it.","Therapist: ""Mm-hmm.""
Patient: ""I think I'm fairly confident.""
Therapist: ""That that's true?""",125.36,136.79
073_019,073,19,2,"Like, I will never get robbed again. Right.","Therapist: ""And that's a really good point about adaptive responses. They have a realism to them.""
Patient: ""Yeah.""
Therapist: ""So as you create these, don't think that they have to be all positive and good.""",150.99,153.15
073_025,073,25,1,"I'm glad you said that because what I was trying and why, you know, I decided to come into counseling is because I was trying to just tell myself, oh, well, that couldn't happen. Like, your car's okay. blanket statement like oh you're crazy that would never happen sort of thing and then I was in my mind was easily able to refute that and say well it did happen so I was having this like dialogue inside my head and when I was just telling myself oh don't worry it wasn't successful at all and now I see why that you know it's okay to be realistic and say well it could happen but then I would get through it as opposed to just saying oh that would never happen again because it did So it wasn't a very powerful, you know, self-talk.","Therapist: ""So you're willing, in cognitive therapy, you're willing to really look at the situation realistically, the good and the bad, and put that together in the adaptive response. Okay. The key feature of the adaptive response is that it's realistic and oftentimes automatic thoughts really expand on the dangers.""
Patient: ""Yeah.""
Therapist: ""They're usually unrealistic.""",205.28,253.42
073_027,073,27,1,"Yeah, exactly. It wasn't helpful at all. So, you know, now I see why it wasn't helpful because it wasn't realistic that I would just say, oh, this would never happen to me again or something like that. Like, it's so easy to say, oh, well, don't worry. Like, people say, like my husband or other people say, oh, don't worry about it. Well... you know, I had a very real thing happen to me, so a realistic adaptive response that you're saying is, I think, a lot easier to believe than something that's completely, you know, too hard to believe.","Therapist: ""They're usually unrealistic.""
Patient: ""I'm glad you said that because what I was trying and why, you know, I decided to come into counseling is because I was trying to just tell myself, oh, well, that couldn't happen. Like, your car's okay. blanket statement like oh you're crazy that would never happen sort of thing and then I was in my mind was easily able to refute that and say well it did happen so I was having this like dialogue inside my head and when I was just telling myself oh don't worry it wasn't successful at all and now I see why that you know it's okay to be realistic and say well it could happen but then I would get through it as opposed to just saying oh that would never happen again because it did So it wasn't a very powerful, you know, self-talk.""
Therapist: ""You were easily able to challenge that self-talk.""",256.04,292.0
073_031,073,31,2,"I think I was thinking, like, I just need to get over it and just be not anxious at all, but I feel like... And then the guilt that comes with not getting over it so quickly when other people or I tell myself that I should, that it's okay to kind of live in that low anxiety for now. you know, until, since it was somewhat recent. So we can kind of get through it.","Therapist: ""Absolutely. Yeah. It's very much so okay to be realistic when we craft these responses. We really want them to be legitimately something we can believe.""
Patient: ""Yeah.""
Therapist: ""The adaptive responses have to be believable. And that means that some of them contain pieces that may not relieve all the anxiety. Like when you admit that it could happen again, it's a little anxiety provoking. But at the same time, by accepting that that could happen again, you're really taking the power away. If you're okay with, like I mentioned before, if you're okay with the worst possible outcome, that's really the ultimate protection against anxiety.""",337.13,363.12
074_003,074,3,1,"Yeah, exactly. That makes me feel really better to kind of say that.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. Yeah, and if you have an automatic thought related to that guilt, something like, I must not be normal to be anxious now. Yeah, exactly.""
Patient: ""Yeah, exactly.""
Therapist: ""You can do the same thing, and I think Really, you just already did it, which is to apply self-talk to say that, well, some anxiety is normal when you get robbed.""",51.86,58.59
074_005,074,5,1,"Yeah, so in the future you're saying, like, if I get anxious about something else or whatnot, that I can kind of identify that emotion and an automatic thought, and then from there apply self-talk to kind of get myself out of it.","Therapist: ""You can do the same thing, and I think Really, you just already did it, which is to apply self-talk to say that, well, some anxiety is normal when you get robbed.""
Patient: ""Yeah, exactly. That makes me feel really better to kind of say that.""
Therapist: ""So this kind of connects to what I was saying before, that this is a skill. This is a skill set that you can really just keep going back to and plugging in. different variables, so to speak. So it's one automatic thought, it's another. It really doesn't matter what the thought is. You're putting them all into the same formula.""",80.34,95.05
074_007,074,7,1,"Yeah, it makes a lot of sense.","Therapist: ""So this kind of connects to what I was saying before, that this is a skill. This is a skill set that you can really just keep going back to and plugging in. different variables, so to speak. So it's one automatic thought, it's another. It really doesn't matter what the thought is. You're putting them all into the same formula.""
Patient: ""Yeah, so in the future you're saying, like, if I get anxious about something else or whatnot, that I can kind of identify that emotion and an automatic thought, and then from there apply self-talk to kind of get myself out of it.""
Therapist: ""Exactly, and it requires some work and some thought, but you seem like you're really connected to this skill set, like you seem to understand how this works.""",108.5,112.43
074_021,074,21,2,Yeah.,"Therapist: ""We believe that those come into existence because some sort of underlying belief, an expectation, an attitude, a rule, combines. And this expectation or rule is always there. But then it's activated when it combines with something that happens in our life.""
Patient: ""Okay.""
Therapist: ""You can call it a situation, a stressor. Clearly, you had a stressor with this card being stolen.""",241.98,244.25
074_023,074,23,2,"Okay. So like, not a thought, but like a deeper held, like, rule or belief under that.","Therapist: ""You can call it a situation, a stressor. Clearly, you had a stressor with this card being stolen.""
Patient: ""Yeah.""
Therapist: ""So there was some belief, some expectation, attitude, rule that you had, that when combined with this terrible stressor, brings these automatic thoughts up.""",259.71,264.43
074_027,074,27,2,Like maybe like how I was raised or something like that? Like things that maybe I learned?,"Therapist: ""Exactly.""
Patient: ""Yeah.""
Therapist: ""And again, this has nothing to do with being bad or good or normal or not normal. These are beliefs that all people have.""",274.5,278.89
075_001,075,1,2,"You mean, like, what does it mean, like, about me, or what does it mean?","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. What's it mean? So I'm working on getting at these beliefs. Let's take a look at automatic thought of, you know, someone's in your house, right? And let's look at the meaning. So what is that? When you have the automatic thought, someone's in my house right now, what does that mean to you?""",50.73,57.26
075_003,075,3,2,"I would say that if someone's in my house, then my stuff isn't safe or, like, I'm not safe.","Therapist: ""Hi, this is Dr. Grande. I hope you find this video useful. If that's the case, please like it and subscribe to my channel. As always, thanks for watching. What's it mean? So I'm working on getting at these beliefs. Let's take a look at automatic thought of, you know, someone's in your house, right? And let's look at the meaning. So what is that? When you have the automatic thought, someone's in my house right now, what does that mean to you?""
Patient: ""You mean, like, what does it mean, like, about me, or what does it mean?""
Therapist: ""Yeah, what does it mean, yeah, exactly, what does it mean about you, what does it mean to you in your life? Kind of a deep level. What is the meaning behind that?""",74.3,82.41
075_005,075,5,4,"Like, people can just take what they want, you know, and then I can't do anything.","Therapist: ""Yeah, what does it mean, yeah, exactly, what does it mean about you, what does it mean to you in your life? Kind of a deep level. What is the meaning behind that?""
Patient: ""I would say that if someone's in my house, then my stuff isn't safe or, like, I'm not safe.""
Therapist: ""Oh, good. Good. I mean, good that you identify the belief.""",85.21,88.75
075_013,075,13,2,"Right, exactly like that. Like, my stuff's not safe, I'm not safe.","Therapist: ""Right. So, it's good that you can identify these things. It's very good. So, people can take what they want. I'm helpless.""
Patient: ""Yeah.""
Therapist: ""That's what it means if somebody can just walk into your house.""",111.38,114.82
075_015,075,15,1,"Yeah, exactly.","Therapist: ""That's what it means if somebody can just walk into your house.""
Patient: ""Right, exactly like that. Like, my stuff's not safe, I'm not safe.""
Therapist: ""I'm not safe. So, the automatic thought might be, there's somebody in my house right now. But what you believe, kind of at a deeper level than that, or another level of thinking... Yeah. I'm not safe.""",132.58,136.29
075_019,075,19,2,"I would say one thing that's been going through my mind is that because the person who did it lives in my neighborhood, that they're right there, that they could do it again. You know what I mean? So that they could do it again, because they live right there. Like, I know this person.","Therapist: ""And that belief could combine with other situations and give rise to other thoughts. Okay. Right? So, ultimately, we want to be able to attack, challenge that belief too.""
Patient: ""Okay.""
Therapist: ""Right? And evaluate it. Yeah. So as Cognitive therapists were always looking to evaluate critically evaluate evidence Okay, what evidence supports that? You're not safe obviously the car being stolen right but But more than that is there any other evidence that supports this? Belief that you're not safe.""",182.68,200.7
075_021,075,21,1,"Besides the fact that it did happen to me when my car was stolen, there's really not too much else. Like you were saying before, it hasn't happened before. I haven't been robbed in that way before in my life, and certainly not in the neighborhood.","Therapist: ""Right? And evaluate it. Yeah. So as Cognitive therapists were always looking to evaluate critically evaluate evidence Okay, what evidence supports that? You're not safe obviously the car being stolen right but But more than that is there any other evidence that supports this? Belief that you're not safe.""
Patient: ""I would say one thing that's been going through my mind is that because the person who did it lives in my neighborhood, that they're right there, that they could do it again. You know what I mean? So that they could do it again, because they live right there. Like, I know this person.""
Therapist: ""And that's... that's true. Right? They're... they're not in jail or prison or anything, and they did it before. Right. So... you're right. That's... that is evidence that supports that You are not safe. Anything else? So this person being kind of free, and having done that before, that's one piece.""",228.78,245.87
075_023,075,23,2,"Yeah, like now that I'm thinking about it and kind of, you know, since the beginning of the session talking about evidence, you know, we did, like you said, take measures to do things so that we were safe and it hasn't happened before. It was kind of like an isolated incident, so... But, like I said, it feels... I feel very unsafe in the moment.","Therapist: ""And that's... that's true. Right? They're... they're not in jail or prison or anything, and they did it before. Right. So... you're right. That's... that is evidence that supports that You are not safe. Anything else? So this person being kind of free, and having done that before, that's one piece.""
Patient: ""Besides the fact that it did happen to me when my car was stolen, there's really not too much else. Like you were saying before, it hasn't happened before. I haven't been robbed in that way before in my life, and certainly not in the neighborhood.""
Therapist: ""Alright, so there's some evidence that you're not safe. Right. But it also sounds like what you're saying, you're finding evidence that that's not true, that actually you are somewhat safe.""",258.78,286.79
075_027,075,27,2,"Yeah, I think so.","Therapist: ""Right, so you feel unsafe, and there's certainly evidence to support that you are unsafe.""
Patient: ""Right.""
Therapist: ""But there's also a lot of evidence to support that you're relatively safe.""",299.65,301.87
075_035,075,35,2,"And I think it's hard sometimes, too, that depending on my mood and what's in the situation, I'm more inclined to believe, like you said, a more powerful thought, even though there's not a lot of evidence. But when I'm calm, I can, like, rationally think there's more evidence to support this than this. know but it depends on what's going on which one i kind of cool like i'll want to believe the evidence that supports what i'm thinking right right in the moment yeah in the moment yeah","Therapist: ""That's just something, really, that's not so much a You know, you need to answer this right or wrong, which is something to think about.""
Patient: ""Yeah.""
Therapist: ""We like to think of utility.""",340.69,376.12
076_007,076,7,1,"Yeah, I think that when you were saying writing it down and stuff, like right after it happens, I think that would kind of, like to write like a pro and con, for lack of a better term list, or like this, and then see which is more likely if I'm having trouble like teasing it out, I think. what you suggested would be helpful.","Therapist: ""And sometimes it's only afterward we can really stop and say, let me really work this out.""
Patient: ""Right.""
Therapist: ""Let me do the math, so to speak. And you'll see that you might have overestimated the risk.""",56.84,75.53
076_013,076,13,1,"Okay, so like my emotion and then the heat of the moment thought right before it.","Therapist: ""So I know that the tendency sometimes is to think, oh, homework. Yeah. Well, there's an automatic thought associated with it, right? Right. Which should be, you know, this is a waste of time or I can still benefit from the therapy without it. And, of course, you could. But I would say, you know, you want to get the most out of this experience. I would say try to engage to the degree you can. In the homework activity like the practice you were talking about yeah, and we'll get into kind of more involved homework as we kind of moved move through the cognitive model and Deeper into the therapy, but for now what I'd like you to do is when you have that feeling of anxiety worry dread Sadness anger right the different emotions we've talked about Just try to write down what was going through your mind before that emotion was noticed. Okay. If you want to create self-talk to address those thoughts, that's great.""
Patient: ""Okay.""
Therapist: ""But for this week, all I really want to focus on is just capturing those thoughts. Anything you do above that is wonderful and I encourage it.""",179.99,184.46
076_019,076,19,2,And what did you say that was called again? I think you said like a thought log or something like that.,"Therapist: ""And I realize that that can be a little inconvenient and it's a skill you have to kind of get used to.""
Patient: ""Okay.""
Therapist: ""But I would say if you could capture, like in this week, maybe five. five thoughts. I think that would be plenty to work with next session. Okay. give us a lot of opportunity to really explore the beliefs, the situation, and then to create those adaptive responses.""",226.94,232.89
076_023,076,23,1,"Okay, great.","Therapist: ""Yeah, there's an actual record, a form that we'll get into that has some other elements too.""
Patient: ""But this I could do in like a notebook?""
Therapist: ""Yeah. Okay, excellent. I think a notebook would be perfect. And then as we get a little farther down the road, We can get into the thought record. I'll show you where that piece goes into the thought record. There's a lot in the thought record to handle in one session. We'll take that kind of over a few sessions. Okay. But once you kind of get toward the end of this therapy, you'll have that and some other tools, and you'll be comfortable using that. This would be a good first step.""",271.62,273.9
076_027,076,27,2,"Yeah, I think it definitely, although my anxiety was higher when we were kind of talking about it, I think it was comforting to kind of work through steps that I could take for myself to kind of calm myself down in the moment.","Therapist: ""I'd like to wrap up by asking a few things. One is asking if you have any questions for me.""
Patient: ""I don't think so.""
Therapist: ""You feel pretty comfortable?""",281.78,296.36
077_005,077,5,2,I have family coming into town and I have to go to the airport to pick them up.,"Therapist: ""Doing well?""
Patient: ""Oh, okay.""
Therapist: ""What's going on?""",22.62,26.63
077_007,077,7,2,"Yes. That's something that I get very anxious about, having to cross the bridge. I have to cross the Ben Franklin Bridge and then get over the bridge that goes to the airport by the stadium. I think that's the Girard Point Bridge. Girard Point? Yeah, that's two levels there. I have to do that both ways, going and coming.","Therapist: ""What's going on?""
Patient: ""I have family coming into town and I have to go to the airport to pick them up.""
Therapist: ""So you have family flying in?""",29.81,51.9
077_011,077,11,5,"I get very anxious, even just thinking about it right now. I'm very anxious about it, yes.","Therapist: ""Both ways? So you have to cross four times?""
Patient: ""Yes.""
Therapist: ""So what kind of feeling is this bringing up for you?""",61.34,66.32
077_013,077,13,2,"Right now, probably an eight.","Therapist: ""So what kind of feeling is this bringing up for you?""
Patient: ""I get very anxious, even just thinking about it right now. I'm very anxious about it, yes.""
Therapist: ""So you're anxious right here with me? Yes. So I want to try to scale this. We talked about this before with cognitive therapy. So let's say that 10 is really the most anxious you ever felt about crossing bridges, right? And one is no anxiety. Where would you be right now?""",88.96,91.28
077_015,077,15,2,"Yes. Painful. It's worse when I'm at that point on that day. But right now, I think just... knowing that I have to do that, yes.","Therapist: ""So you're anxious right here with me? Yes. So I want to try to scale this. We talked about this before with cognitive therapy. So let's say that 10 is really the most anxious you ever felt about crossing bridges, right? And one is no anxiety. Where would you be right now?""
Patient: ""Right now, probably an eight.""
Therapist: ""Eight? Yeah. A lot of anxiety.""",92.4,100.71
077_021,077,21,1,"Ten minutes to work every day and back, so 20 minutes I'm going to shopping centers and everything. It's just within the vicinity. I don't have to cross any bridges.","Therapist: ""All right. So, but even now, how far away is the, until they... Oh, it's a week. It's a week, okay. Yeah. So even now, a week out, this is an eight. This is really, this is hurting.""
Patient: ""Yes, I don't like that at all.""
Therapist: ""So for your job and local travel, you don't really have to cross any...""",127.35,137.04
077_023,077,23,1,"No, not at all. I probably planned it that way too. I don't know. That worked out well. It worked out very well.","Therapist: ""So for your job and local travel, you don't really have to cross any...""
Patient: ""Ten minutes to work every day and back, so 20 minutes I'm going to shopping centers and everything. It's just within the vicinity. I don't have to cross any bridges.""
Therapist: ""All right, so no bridges.""",139.92,148.12
077_025,077,25,2,"It's going to be a 4 o'clock flight in the afternoon. In the afternoon, okay.","Therapist: ""All right, so no bridges.""
Patient: ""No, not at all. I probably planned it that way too. I don't know. That worked out well. It worked out very well.""
Therapist: ""All right, but coming up, pick up the family, you will be crossing. Yes. So let's look at this at each stage. So, I mean, you're clearly anxious now, as you mentioned. But let's go to, let's try to move forward a week to the day that they'll be flying in. What time do they fly in?""",166.99,169.59
077_027,077,27,1,"I would have to leave probably at 3 o'clock, because it's only about 20 minutes to the airport, really.","Therapist: ""All right, but coming up, pick up the family, you will be crossing. Yes. So let's look at this at each stage. So, I mean, you're clearly anxious now, as you mentioned. But let's go to, let's try to move forward a week to the day that they'll be flying in. What time do they fly in?""
Patient: ""It's going to be a 4 o'clock flight in the afternoon. In the afternoon, okay.""
Therapist: ""So about what time would you have to leave to?""",172.3,177.31
077_029,077,29,1,"But I would like to leave earlier. It would probably take them time by the time they land and go through, you know, getting their luggages. They probably won't even come out until maybe 4.30, but I'd like to make sure I'm there at around 3.30, 4 o'clock.","Therapist: ""So about what time would you have to leave to?""
Patient: ""I would have to leave probably at 3 o'clock, because it's only about 20 minutes to the airport, really.""
Therapist: ""Really?""",177.79,195.0
077_031,077,31,3,Um... I have to do this. I have to get up and go. They need me to be there. This week it's my parents coming in and they're elderly. So I don't want them to be stuck at the airport. There's no one else that actually can go pick them up. So I have to get up and go and pick them up.,"Therapist: ""Really?""
Patient: ""But I would like to leave earlier. It would probably take them time by the time they land and go through, you know, getting their luggages. They probably won't even come out until maybe 4.30, but I'd like to make sure I'm there at around 3.30, 4 o'clock.""
Therapist: ""All right, so let's go to that day. Let's go to that day and to that afternoon. Okay. So you're still at home, and let's say we're about 15 minutes before you have to get in the car. What are you thinking then?""",213.08,234.48
077_033,077,33,3,"That's what's going through my mind. There's nobody else that can do this. I mean, it's cheaper than... I probably can't even afford to... get a taxi for them because you'd have to cross, that's from Philly to New Jersey, so that's going to be very expensive. I can't afford that when all I'd have to do is pay $5 for the toll and maybe gas up my car for $10 or something. But I'll be thinking about, I have to do this, no one else can do it. It's something that I can save money that way, and I don't want to leave them stranded, definitely. Someone else can, I mean, they'd be lost. They're not familiar with the airport. And Philly airport is crazy to me. Yeah.","Therapist: ""All right, so let's go to that day. Let's go to that day and to that afternoon. Okay. So you're still at home, and let's say we're about 15 minutes before you have to get in the car. What are you thinking then?""
Patient: ""Um... I have to do this. I have to get up and go. They need me to be there. This week it's my parents coming in and they're elderly. So I don't want them to be stuck at the airport. There's no one else that actually can go pick them up. So I have to get up and go and pick them up.""
Therapist: ""That's what's going through your mind?""",235.6,277.56
077_035,077,35,4,"Just the thought of the bridge. I could drive off the bridge. I can fall off. Usually what I do is try to stay in the middle lane. I can't do more than 40 miles an hour. I'm shaking. I have the radio on and windows down because I can't swim. So for any reason I'm to fall off. That's it for me. I even have a little metal, one of those, I think it's an instrument that you use in the house for, I don't know, plier or something, something real hard that I can hit the glass with. It sits right there on my door, on the side of my door. So I'm already, I planned, and I have that planned ahead of time. I know what I'm going to do as soon as I approach the bridge. But I still feel anxious, even though I'll be there.","Therapist: ""That's what's going through your mind?""
Patient: ""That's what's going through my mind. There's nobody else that can do this. I mean, it's cheaper than... I probably can't even afford to... get a taxi for them because you'd have to cross, that's from Philly to New Jersey, so that's going to be very expensive. I can't afford that when all I'd have to do is pay $5 for the toll and maybe gas up my car for $10 or something. But I'll be thinking about, I have to do this, no one else can do it. It's something that I can save money that way, and I don't want to leave them stranded, definitely. Someone else can, I mean, they'd be lost. They're not familiar with the airport. And Philly airport is crazy to me. Yeah.""
Therapist: ""It's a big place. A lot going on. So you're sitting at home and 15 minutes before you get in the car and you're thinking, I have to do this. But your reasons are positive. Like you save money and protect your parents from having to be there alone. So when does the anxiety come in?""",302.46,354.72
077_037,077,37,4,"I say a prayer. I'm still anxious. I turn on the radio. And the closer I get to, especially the toll, Point and I know it's at me and you see those lights flashing last exit before the you know You know you're going over one. Yeah, I have no there's no turning back.","Therapist: ""It's a big place. A lot going on. So you're sitting at home and 15 minutes before you get in the car and you're thinking, I have to do this. But your reasons are positive. Like you save money and protect your parents from having to be there alone. So when does the anxiety come in?""
Patient: ""Just the thought of the bridge. I could drive off the bridge. I can fall off. Usually what I do is try to stay in the middle lane. I can't do more than 40 miles an hour. I'm shaking. I have the radio on and windows down because I can't swim. So for any reason I'm to fall off. That's it for me. I even have a little metal, one of those, I think it's an instrument that you use in the house for, I don't know, plier or something, something real hard that I can hit the glass with. It sits right there on my door, on the side of my door. So I'm already, I planned, and I have that planned ahead of time. I know what I'm going to do as soon as I approach the bridge. But I still feel anxious, even though I'll be there.""
Therapist: ""So you're anxious before you leave, and you're starting to think about the bridge at that point. You're already thinking about it. How about when you get in your car? You start driving toward the bridge.""",366.96,387.46
077_039,077,39,4,Before when I can still exit. Yeah It's probably still high it's probably at a nine or so It's still high.,"Therapist: ""So you're anxious before you leave, and you're starting to think about the bridge at that point. You're already thinking about it. How about when you get in your car? You start driving toward the bridge.""
Patient: ""I say a prayer. I'm still anxious. I turn on the radio. And the closer I get to, especially the toll, Point and I know it's at me and you see those lights flashing last exit before the you know You know you're going over one. Yeah, I have no there's no turning back.""
Therapist: ""There's no turning back So before that when you can still exit, what's your anxiety level?""",393.49,405.2
077_041,077,41,4,"Yeah, I think it's pretty bad at that point.","Therapist: ""There's no turning back So before that when you can still exit, what's your anxiety level?""
Patient: ""Before when I can still exit. Yeah It's probably still high it's probably at a nine or so It's still high.""
Therapist: ""Okay, but it's not maxed out yet, but it's pretty bad.""",407.8,410.35
077_047,077,47,2,"As soon as I'm getting close to getting off the bridge, I'm now heaving a little sigh of relief. There's a little release there. And I know that I've been able to manage those two, three minutes of cross, I don't know how many minutes it takes actually. of crossing the bridge, I start feeling a little bit of relief. But then again, I know I have to take that exit, and there's another one coming right up, so it starts all over again.","Therapist: ""So, your specific fear as you start to cross, this is the Ben Franklin, the first bridge, right, you can go across, is that your car will go off the bridge.""
Patient: ""Yes, definitely.""
Therapist: ""And when does that, so that's a 10, that anxiety, when does that anxiety start to go away?""",436.53,461.65
077_049,077,49,1,"Oh, as soon as I'm descending from the Girard Point Bridge, there's less, you know, it's almost reduced. I come, you know, really low.","Therapist: ""And when does that, so that's a 10, that anxiety, when does that anxiety start to go away?""
Patient: ""As soon as I'm getting close to getting off the bridge, I'm now heaving a little sigh of relief. There's a little release there. And I know that I've been able to manage those two, three minutes of cross, I don't know how many minutes it takes actually. of crossing the bridge, I start feeling a little bit of relief. But then again, I know I have to take that exit, and there's another one coming right up, so it starts all over again.""
Therapist: ""All right, so then you cross the second bridge, the draw point bridge. You go to the airport. Does your anxiety drop any of those points?""",468.63,476.76
077_053,077,53,2,"As soon as I exit, I'm getting back on 95 going north, and I know, here we go again. And cars are zooming by.","Therapist: ""It's almost gone.""
Patient: ""Yes, it's almost gone, yes.""
Therapist: ""And when do you start thinking about that you're going to have to cross them again?""",482.1,493.28
077_055,077,55,2,"No, no. I'm that person in the middle lane doing 40 miles an hour. Yes. All right.","Therapist: ""And when do you start thinking about that you're going to have to cross them again?""
Patient: ""As soon as I exit, I'm getting back on 95 going north, and I know, here we go again. And cars are zooming by.""
Therapist: ""Because you're not going very quickly.""",494.72,501.73
077_057,077,57,4,"Yes. Especially when there are those big trucks, tractor trailers coming.","Therapist: ""Because you're not going very quickly.""
Patient: ""No, no. I'm that person in the middle lane doing 40 miles an hour. Yes. All right.""
Therapist: ""So you're doing everything you can to keep your car on the bridge. But you're still feeling anxiety. Like you're going to... Go off the bridge. Yes. The whole time until you start really descending. Exactly. And then you feel like you've made it.""",521.83,526.01
077_059,077,59,4,"Yes, yes. Or if it's also in bad weather or at night, it's worse. Because on the bridge, especially the top one, you kind of see the sky and there's nothing else you see. So it's like you're going to fall off. Yes.","Therapist: ""So you're doing everything you can to keep your car on the bridge. But you're still feeling anxiety. Like you're going to... Go off the bridge. Yes. The whole time until you start really descending. Exactly. And then you feel like you've made it.""
Patient: ""Yes. Especially when there are those big trucks, tractor trailers coming.""
Therapist: ""Because the air.""",528.11,543.27
077_061,077,61,2,On the lower level coming back it's not as bad because you're kind of like protected here and there. So it's not as bad but going is definitely worse. Yes.,"Therapist: ""Because the air.""
Patient: ""Yes, yes. Or if it's also in bad weather or at night, it's worse. Because on the bridge, especially the top one, you kind of see the sky and there's nothing else you see. So it's like you're going to fall off. Yes.""
Therapist: ""So on the lower level... It's not as bad?""",546.62,558.19
077_063,077,63,1,I hear on the news once in a while you'll hear something happen or sometimes in movies you see things happen and I think it's possible.,"Therapist: ""So on the lower level... It's not as bad?""
Patient: ""On the lower level coming back it's not as bad because you're kind of like protected here and there. So it's not as bad but going is definitely worse. Yes.""
Therapist: ""Are you aware of any time a car would have gone off the bridge?""",563.36,575.46
077_065,077,65,1,"No, maybe not on that Girard Bridge because I noticed I was checking it the other day. I had to go to the airport and I was trying to measure the distance between the metal poles just to see if a car could fit there really. And I think a car could fit there but you know it just depends on the angle you were hit or something or if you flipped. So, yeah, I've done some thinking.","Therapist: ""Are you aware of any time a car would have gone off the bridge?""
Patient: ""I hear on the news once in a while you'll hear something happen or sometimes in movies you see things happen and I think it's possible.""
Therapist: ""Do you think it's a high risk?""",580.4,602.76
077_069,077,69,1,I don't even recall all the anxiety or why it was such a big deal anyway. I don't think about it at all.,"Therapist: ""So you've done some calculations and some geometry, right? And you've concluded that it's not really likely, but it could. It could. It could fly off the... All right, but either way, your anxiety is maxed out on each bridge.""
Patient: ""Yes.""
Therapist: ""Now, when you get home, when you... get your parents back to your home. Yes. How do you feel then?""",630.28,636.75
077_073,077,73,1,"It would save me money because I would be the one calling the cab. You'd be the one calling the cab, okay. But I would be the one to pick them up and save them from being stranded at the airport and being in a land that they're not familiar with and an area they're not familiar with. So make sure that they're safe.","Therapist: ""Alright, so when you arrive home, you're down to one? Yes. Alright, so going back to the first stage, like when you're getting ready, you're thinking that you have to go.""
Patient: ""Yes.""
Therapist: ""And it would save your parents' money?""",661.65,679.45
077_081,077,81,2,"It's worth it, yes. It's tough for you. Yeah, it's still something that bothers me that I have to do, but yeah, it's worth the anxiety, I would say so.","Therapist: ""So, I mean, clearly, it sounds like you've picked them up before.""
Patient: ""Yes.""
Therapist: ""So, picking them up is, it's worth all the anxiety.""",700.98,710.59
077_083,077,83,2,"Yes. I wish there was another route that I could take and make it to the airport without any bridges at all, but that's not...","Therapist: ""So, picking them up is, it's worth all the anxiety.""
Patient: ""It's worth it, yes. It's tough for you. Yeah, it's still something that bothers me that I have to do, but yeah, it's worth the anxiety, I would say so.""
Therapist: ""It's worth it, but you wish that you could do it without anxiety.""",714.55,723.84
077_087,077,87,4,"As long as I can remember that I'd... Maybe not when I was younger, but perhaps as a mother and as someone, as I got older and had responsibilities and knew that life was important. I mean, prior to maybe marriage and kids, I didn't have that anxiety. I don't recall having that, even driving or anything like that. I don't recall that.","Therapist: ""There's no route without any bridges.""
Patient: ""...yet to find, yeah.""
Therapist: ""And how long have you had the anxiety with driving on bridges?""",735.89,768.05
077_089,077,89,2,"Yes, yes.","Therapist: ""And how long have you had the anxiety with driving on bridges?""
Patient: ""As long as I can remember that I'd... Maybe not when I was younger, but perhaps as a mother and as someone, as I got older and had responsibilities and knew that life was important. I mean, prior to maybe marriage and kids, I didn't have that anxiety. I don't recall having that, even driving or anything like that. I don't recall that.""
Therapist: ""All right, but it developed along the way somewhere, and it's been with you ever since?""",773.61,775.69
077_093,077,93,2,I never really thought of it like that.,"Therapist: ""Okay. So I'd like to do what in cognitive therapy we call a reframe. Okay. And actually you've kind of already done it, but I want to make it a little clearer. So you suffer the anxiety, and you suffer it to protect, mostly to protect your parents. Yes. Right? So as you're going over the bridge, you're thinking about the automatic thought, we talked about these before, right? The thought that kind of pops in your mind is I'm gonna fly off the bridge. Yes. All right. So that seems pretty unlikely, right? That's not something that, maybe as you talked about geometrically, maybe there's a way that your car could fly off the bridge and you know, with physics and all, maybe it could happen, but it seems like it would be fairly unlikely. So you could challenge that, and this isn't the reframe part, but you could challenge that on that thought which, with a statement and adaptive response like, it's pretty unlikely anything's going to happen. That might help a bit, keep applying that. the chances are vastly in your favor, right, considering how many cars cross that bridge and how many fly off the bridge, right? I don't know if I've ever heard of a car fly off one of those bridges. But the other, you know, the reframe part is that you're doing this, you're willing to take on the bridges and have this anxiety for the betterment of your parents, for their safety.""
Unknown: ""Yes.""
Therapist: ""So in this whole equation of crossing bridges and anxiety, you're really the good guy in this. You're willing to suffer and overcome fear to make sure your parents are safe.""",901.14,906.49
077_095,077,95,2,"But you've never really connected it to... No, I haven't connected it to their safety or their security and all that.","Therapist: ""So in this whole equation of crossing bridges and anxiety, you're really the good guy in this. You're willing to suffer and overcome fear to make sure your parents are safe.""
Patient: ""I never really thought of it like that.""
Therapist: ""Okay. Yeah, I mean, and you've thought about it before. Before you leave, you think, I really have to pick him up.""",912.93,919.66
077_097,077,97,1,"Does that make sense? Yes, it does. It does. Yes. Like, I'm the hero, I guess. In my family's eyes, my brothers and sisters appreciate that in me, and they know that I... Yes.","Therapist: ""Okay. Yeah, I mean, and you've thought about it before. Before you leave, you think, I really have to pick him up.""
Patient: ""But you've never really connected it to... No, I haven't connected it to their safety or their security and all that.""
Therapist: ""Well, and to being the good guy. Well, yeah, okay.""",923.49,937.65
077_101,077,101,2,So think of that terms at the beginning of that day?,"Therapist: ""Yeah. You've overcome it before to pick them up. And when you pick them up again, you'll overcome it again. And you'll suffer, but the difference here is that that reframe, I want you to apply that reframe when you're feeling that anxiety as you get ready to leave and as you drive toward the bridge, that you're really, you know, you're doing what you feel is right for the good of your family.""
Unknown: ""Yes.""
Therapist: ""So the automatic thought that's going to come in is you're going to fly off the bridge. That's what the anxiety is about, this fear. And the reframe, in this case the reframe and adaptive response is I'm doing this for my family. And the probability is pretty low that So I have the bridge. That's a separate thing. But the reframe is, I'm the hero of this. I think that's a great way to look at it. You're the hero of this situation.""",998.39,1001.65
077_103,077,103,2,"Okay, I can do that.","Therapist: ""So the automatic thought that's going to come in is you're going to fly off the bridge. That's what the anxiety is about, this fear. And the reframe, in this case the reframe and adaptive response is I'm doing this for my family. And the probability is pretty low that So I have the bridge. That's a separate thing. But the reframe is, I'm the hero of this. I think that's a great way to look at it. You're the hero of this situation.""
Patient: ""So think of that terms at the beginning of that day?""
Therapist: ""Thinking of the whole day, yeah. Just kind of go over that. Rather than something you must do. Because really you don't have to do it. Strictly speaking. I know you feel you have to do it. But you're willing to do it, you're willing to sacrifice and suffer to do it. And I'd rather that be the theme that you're getting, it's a positive theme, that you're willing to do what has to be done. It's uncomfortable. You'll survive it, but it's uncomfortable. And focus on that kind of reframe than focusing on the very low probability that, or the risk that you're going to fly off the bridge. That's a very low risk.""",1046.17,1048.77
077_107,077,107,2,"There was a day when there was a lot of thunderstorm and there was wind. So I could literally feel the car shaking on the bridge. And there was a day I think I was coming into Delaware I had to stop and call those, they say if you need help crossing the bridge, I stopped and called them. But they talked to me for about half an hour or so, and then they told me that it would take another hour for someone to literally be able to come and get me. And this was like, I was leaving here, it was probably around 10, 10.30 class was over, I was on the bridge, and it was late at night, raining, and I just, I couldn't do it. But After a while I think I calmed down with their conversation and I was able to just take it easy in that middle lane. And I did it.","Therapist: ""Does that kind of make sense?""
Patient: ""Yeah, it makes sense. It makes sense.""
Therapist: ""So it's not so much being forced to do it, being forced into an anxious situation. You're voluntarily being brave. I know it's hard. It's hard for you. You're saying it's a 10 on the anxiety scale. That's the highest score, right? So it's hard for you. But the way to look at it, maybe, would be You're doing what has to be done. You're doing for the good of your family. They need you. Have you ever had any close calls on a bridge or anything?""",1093.52,1140.79
077_113,077,113,2,I can try that. Just thinking in that positive way that I've done this before and I can do it again.,"Therapist: ""And that might be another good automatic thought, or adaptive response to that automatic thought, is that I've always managed to overcome this. And it hurts, but I've managed to overcome it. Yes. And by kind of taking charge like that and being assertive, that might help reduce that automatic thought.""
Patient: ""Okay.""
Therapist: ""Do you think you could try that this time?""",1166.53,1172.28
078_001,078,1,2,"All right so um One thing that I've been noticing lately is that I have a tendency to kind of hang back in groups. And I tend to observe instead of participate. And a lot of times I get really nervous when I feel like I'm expected to speak up. And I want to speak up, but I kind of feel like I freeze.","Therapist: ""Meredith, we know each other, but the way we usually start a CBT session is to set an agenda. So we might have several ideas about what we want on the agenda, but the first thing is usually for us to make a problem list together about whatever it is that you might want to work on. And then we'll do the problem list and then we'll explore the thoughts and the behaviors That might be related to the problem and hopefully by the end of our time together We'll have some a clearer idea about what's causing the problem and some ideas about how to maybe change things Sounds good.""",45.33,76.65
078_003,078,3,2,"It doesn't matter a whole lot, but generally I guess","Therapist: ""Meredith, we know each other, but the way we usually start a CBT session is to set an agenda. So we might have several ideas about what we want on the agenda, but the first thing is usually for us to make a problem list together about whatever it is that you might want to work on. And then we'll do the problem list and then we'll explore the thoughts and the behaviors That might be related to the problem and hopefully by the end of our time together We'll have some a clearer idea about what's causing the problem and some ideas about how to maybe change things Sounds good.""
Patient: ""All right so um One thing that I've been noticing lately is that I have a tendency to kind of hang back in groups. And I tend to observe instead of participate. And a lot of times I get really nervous when I feel like I'm expected to speak up. And I want to speak up, but I kind of feel like I freeze.""
Therapist: ""And so in particular then, in groups, the setting is big groups, little groups, does it matter?""",87.02,89.82
078_005,078,5,2,"try to force myself to speak up when I actually don't feel ready, I get like, I feel like my throat's closing and I get a red face.","Therapist: ""And so in particular then, in groups, the setting is big groups, little groups, does it matter?""
Patient: ""It doesn't matter a whole lot, but generally I guess""
Therapist: ""medium-sized like you know in classes that I have so I usually like maybe 12 people or so so relatively small medium I don't know what size that is okay and so but in your head you probably would say I would like to speak up but for some reason you feel inside some anxiety or nervousness about that definitely okay and then sometimes when I""",116.95,128.54
078_008,078,8,2,"So in my statistics class each week we have a, it's called an inclusion activity, and generally I guess it's supposed to help people feel Make the groups more cohesive and included. Okay. But I usually experience it as the opposite. So there's usually a task at the beginning of each class of like take off your shoe and talk about the most interesting place your shoe has been. Stuff like this.","Patient: ""try to force myself to speak up when I actually don't feel ready, I get like, I feel like my throat's closing and I get a red face.""
Therapist: ""Okay. Alright, so that's sort of one possible issue for us to talk about.""
Therapist: ""Could you maybe give me a specific example of a particular group situation, as recent as you can, where you had this feeling of hanging back and maybe some fear of evaluation?""",166.17,194.94
078_010,078,10,2,"Yeah. That usually I get really nervous and I feel like I can't think of anything to say and I feel like I usually end up saying something really awkward or lame and I just don't feel good about it, like I feel... Yeah.","Therapist: ""Could you maybe give me a specific example of a particular group situation, as recent as you can, where you had this feeling of hanging back and maybe some fear of evaluation?""
Patient: ""So in my statistics class each week we have a, it's called an inclusion activity, and generally I guess it's supposed to help people feel Make the groups more cohesive and included. Okay. But I usually experience it as the opposite. So there's usually a task at the beginning of each class of like take off your shoe and talk about the most interesting place your shoe has been. Stuff like this.""
Therapist: ""In stats.""",197.58,217.13
078_012,078,12,2,"Um... Yeah, so when we did this activity, it's like a really weird example. When we did this activity, you know, probably six or seven people had gone in front of me and I was like not listening to anything that anyone else was saying, just totally self-absorbed in terms of like, oh God, what am I going to say? And not being able to think of anything. And then when it was my turn, I was wearing pair of shoes that like are kind of like they have lace on them and so I took it off and I said I like these shoes because I get cool tan lines from them so I didn't even really answer the question that was like where where have these shoes been or like the coolest place these shoes have been or something like that And then after I went, I didn't really listen to anything else anyone said because I was still stuck on why didn't I answer the question and just kind of feeling awkward.","Therapist: ""In stats.""
Patient: ""Yeah. That usually I get really nervous and I feel like I can't think of anything to say and I feel like I usually end up saying something really awkward or lame and I just don't feel good about it, like I feel... Yeah.""
Therapist: ""Can you give me that specific example of the recent time when maybe... And what you said, too, including sort of the beginning, what happened, and then how it ended.""",232.96,298.24
078_014,078,14,4,"Yeah, and like, why can't I ever be articulate?","Therapist: ""Can you give me that specific example of the recent time when maybe... And what you said, too, including sort of the beginning, what happened, and then how it ended.""
Patient: ""Um... Yeah, so when we did this activity, it's like a really weird example. When we did this activity, you know, probably six or seven people had gone in front of me and I was like not listening to anything that anyone else was saying, just totally self-absorbed in terms of like, oh God, what am I going to say? And not being able to think of anything. And then when it was my turn, I was wearing pair of shoes that like are kind of like they have lace on them and so I took it off and I said I like these shoes because I get cool tan lines from them so I didn't even really answer the question that was like where where have these shoes been or like the coolest place these shoes have been or something like that And then after I went, I didn't really listen to anything else anyone said because I was still stuck on why didn't I answer the question and just kind of feeling awkward.""
Therapist: ""Okay. So what I'm doing here is I've got several columns that I'm building. And the first one is you're in the stats class and you're going through an inclusion activity. And the second one is the thoughts that you're having. What thoughts are going through your mind? And the thoughts are, oh God, what am I going to say? Those are the early thoughts. And then maybe the later thoughts are, why didn't I even answer the question?""",327.83,331.37
078_016,078,16,2,"Nervous. Yeah, like fearful and like it's almost like I'm anticipating embarrassment. So I don't know if that's a feeling or not, but usually I feel embarrassed.","Therapist: ""Okay. So what I'm doing here is I've got several columns that I'm building. And the first one is you're in the stats class and you're going through an inclusion activity. And the second one is the thoughts that you're having. What thoughts are going through your mind? And the thoughts are, oh God, what am I going to say? Those are the early thoughts. And then maybe the later thoughts are, why didn't I even answer the question?""
Patient: ""Yeah, and like, why can't I ever be articulate?""
Therapist: ""Okay. Why can't I ever be articulate? Okay. And then our third column is the emotions that you might be feeling. And so as you're in that situation and people are taking their turn, the teacher says you're doing the inclusion activity, people are taking their turns and what are you feeling? How would you describe your emotional state?""",368.66,388.65
078_018,078,18,2,"Maybe fearful, like a four. Okay. Or a five, I don't know.","Therapist: ""Okay. Why can't I ever be articulate? Okay. And then our third column is the emotions that you might be feeling. And so as you're in that situation and people are taking their turn, the teacher says you're doing the inclusion activity, people are taking their turns and what are you feeling? How would you describe your emotional state?""
Patient: ""Nervous. Yeah, like fearful and like it's almost like I'm anticipating embarrassment. So I don't know if that's a feeling or not, but usually I feel embarrassed.""
Therapist: ""I put that in the thought column just because it seems like the anticipation of it is probably a thought. But embarrassment when you're in the middle of it is probably a feeling. Does that make sense? And then, so I got nervous, fearful, embarrassed as the emotions. And on a scale of zero, not at all, a hundred being the most of that feeling you could ever have. How would you rate, let's get rid of nervous because it's sort of covered by fearful. How would you rate fearful and how would you rate embarrassed?""",429.39,434.86
078_024,078,24,1,"Yeah, I'd say like both during and after. Okay.","Therapist: ""A little higher.""
Patient: ""Yeah, like a 70.""
Therapist: ""So maybe a 70. And that would be at the moment that you're talking or right afterwards or right before. Fluctuated at all?""",461.14,467.29
078_026,078,26,4,"Why can't I never be articulate? That sounds exactly like... Yeah, it's perfect.","Therapist: ""So maybe a 70. And that would be at the moment that you're talking or right afterwards or right before. Fluctuated at all?""
Patient: ""Yeah, I'd say like both during and after. Okay.""
Therapist: ""Okay, so during and after. All right, and so you know the cognitive approach to thinking about what's going on is that it's not the situation that causes the emotional reaction, but it's what you're thinking that causes the emotional reaction. And so it seems to me like one of the things that's going on, oh God, what am I going to say? And why didn't I answer? Why can't I never be articulate?""",509.58,515.39
078_028,078,28,2,"Yeah, like I wish I could be more clever or I wish I could have just like a funny story right now or make people laugh in a way that I want them to laugh.","Therapist: ""Okay, so during and after. All right, and so you know the cognitive approach to thinking about what's going on is that it's not the situation that causes the emotional reaction, but it's what you're thinking that causes the emotional reaction. And so it seems to me like one of the things that's going on, oh God, what am I going to say? And why didn't I answer? Why can't I never be articulate?""
Patient: ""Why can't I never be articulate? That sounds exactly like... Yeah, it's perfect.""
Therapist: ""We might have to start rating my anxiety now too. And then I guess there's the other thing you said that you're anticipating embarrassment. And so are those words too also that are going through your head?""",532.72,547.59
078_032,078,32,2,"Um, I can be clever sometimes.","Therapist: ""One of the things I'm doing now is, a lot of times, when you think about the thoughts that trigger the emotions, these are the thoughts that we would categorize as a little less helpful. Kind of unhelpful thoughts. And then over here, what we're doing is we're coming up with some thoughts that might be more helpful. Recognizing that no thoughts are perfect, but some thoughts are more helpful, some thoughts are less helpful. And you know in your SAS class you're going to do the inclusion activity... Every week. Every week. And so one possibility is you could come in prepared to shift your thinking from the less helpful to the more helpful. Just an idea.""
Patient: ""It's a good idea.""
Therapist: ""Okay. So what else besides this is silly and what I say doesn't matter all that much.""",614.51,622.19
078_034,078,34,1,I think that I probably express surprise because I imagine that usually I don't perceive her as inarticulate or as embarrassing as she sees herself.,"Therapist: ""Okay. So what else besides this is silly and what I say doesn't matter all that much.""
Patient: ""Um, I can be clever sometimes.""
Therapist: ""I can be clever sometimes. Good. That's sort of a counter to the why can't I ever be articulate? Or why can't I never be articulate? Either way you say it. Let's pretend for a second that you were talking to a friend who had exactly this same scenario and she was telling you the way that she talks to herself oh god what am i going to say and why can't i answer that why can't i ever be articulate i know i'm going to embarrass myself and so she's talking to herself that way how would you talk to her""",680.45,694.77
078_036,078,36,2,I would tell her that she's funny and charming and usually has really cool stories to tell because she's had lots of good experiences.,"Therapist: ""I can be clever sometimes. Good. That's sort of a counter to the why can't I ever be articulate? Or why can't I never be articulate? Either way you say it. Let's pretend for a second that you were talking to a friend who had exactly this same scenario and she was telling you the way that she talks to herself oh god what am i going to say and why can't i answer that why can't i ever be articulate i know i'm going to embarrass myself and so she's talking to herself that way how would you talk to her""
Patient: ""I think that I probably express surprise because I imagine that usually I don't perceive her as inarticulate or as embarrassing as she sees herself.""
Therapist: ""Okay, so you would be surprised and kind of reassuring to her and say, oh, you don't seem that way. And if you could be on her shoulder in the situation, what would you whisper in her ear? This is a good friend of yours. You want to be helpful.""",721.71,737.88
078_039,078,39,2,"I mean, it sounds pretty ideal, but it sounds really far away from my current experience.","Patient: ""I would tell her that she's funny and charming and usually has really cool stories to tell because she's had lots of good experiences.""
Therapist: ""So you'd be sitting on a shoulder saying things like, you are funny and charming and you have cool stories to tell.""
Therapist: ""What's it feel like when you imagine actually even saying those words to yourself in this kind of situation?""",769.68,778.87
078_042,078,42,4,Mm-hmm. Study.,"Patient: ""I mean, it sounds pretty ideal, but it sounds really far away from my current experience.""
Therapist: ""It's not what you're whispering in your own ear. No. What would stop you from actually doing this, from talking to yourself, just like you would talk to a good friend? Because you're talking to yourself, you're kind of... talking to yourself more like somebody who wanted to pull you down. And so I just think, huh, what about that good friend? I mean, can you be a good friend to yourself in those moments and say something more supportive?""
Therapist: ""you are pretty successful in a variety of different things in your life. Right? And so if you take one of those examples and you kind of break it down, are you able to, what do you do to prepare? Well, for example, even for a statistics test, I would guess that you have to go through some preparation.""",851.9,853.92
078_046,078,46,1,No. I think I maybe was in seventh grade.,"Therapist: ""Study. Mm-hmm. Okay. Kind of like studying. Have you ever been in a, like a play or a dramatic performance at any time?""
Patient: ""Oh no, I avoid that.""
Therapist: ""Not even like in grade school?""",870.12,873.83
078_048,078,48,2,"Yeah, but I had a very small part. Yeah. I've always, like my whole life, shied away from being a center of attention. It never feels good to me.","Therapist: ""Not even like in grade school?""
Patient: ""No. I think I maybe was in seventh grade.""
Therapist: ""Yeah?""",876.23,886.94
078_050,078,50,2,"Which is ironic, since I'm going to school to become a teacher.","Therapist: ""Yeah?""
Patient: ""Yeah, but I had a very small part. Yeah. I've always, like my whole life, shied away from being a center of attention. It never feels good to me.""
Therapist: ""No.""",889.09,891.87
078_056,078,56,5,No. Mm-mm. No.,"Therapist: ""What do you do?""
Patient: ""But it never feels...""
Therapist: ""It never feels comfortable.""",909.93,912.64
078_060,078,60,2,"Unhelpful. It kind of makes me feel like no matter how much I prepare, I still won't feel like I'm good enough or confident.","Therapist: ""So even right now as we're talking, so I hear you say, it never feels comfortable, right? Would you put that thought in the category of helpful or unhelpful? To say that to yourself.""
Patient: ""I'd say that's unhelpful.""
Therapist: ""Unhelpful. Okay. What's unhelpful about that thought?""",940.15,952.13
078_062,078,62,4,Some pretty black and white thinking.,"Therapist: ""Unhelpful. Okay. What's unhelpful about that thought?""
Patient: ""Unhelpful. It kind of makes me feel like no matter how much I prepare, I still won't feel like I'm good enough or confident.""
Therapist: ""Yeah, and just before that you said, I always shied away from attention. It's never felt good.""",965.38,967.99
078_064,078,64,1,"I mean, I definitely think like, you know, if you're nervous about something to a certain extent, that's healthy because it makes you prepare more. But at the same time, that kind of thinking of being like, it will never get better. It'll never be okay. Probably isn't that helpful.","Therapist: ""Yeah, and just before that you said, I always shied away from attention. It's never felt good.""
Patient: ""Some pretty black and white thinking.""
Therapist: ""Well, that is pretty... Yeah, good job noticing that. And I hear you saying that black and white thinking is maybe too general in that it doesn't provide any real hope for it ever changing. And in that sense, it does seem like it fits in that unhelpful category.""",994.7,1010.95
078_069,078,69,2,There are times when I am comfortable in groups.,"Therapist: ""So I wonder if that's maybe, as we think about the preparation stage, that that's one of the things that you said for a stats test you would study. I wonder if there's some way you could study this way that you have been thinking about yourself. I'm just not clever in a group. I'm just not comfortable. I've always shied away from that. I wonder if there would be different ways you could say things to yourself.""
Patient: ""For instance?""
Therapist: ""For instance?""",1055.3,1057.7
078_072,078,72,2,"Yeah. And I feel like I, um, like not really on purpose, but like I end up doing things to like make myself not seem like kind of invisible. And then usually I don't feel like that's as rewarding when I feel engaged and involved in a group.","Patient: ""There are times when I am comfortable in groups.""
Therapist: ""There are times I am comfortable in groups. And that you probably would put into the more helpful thought category.""
Therapist: ""So it seems like you've got this sort of circle of thinking in there that takes you down into a negative place, that the embarrassment kind of starts this negative spiral, takes you downward to, you're probably not consciously thinking, I'll be alone and unhappy, but somehow it's related. People will think you're stupid, they won't want to be around you.""",1107.24,1130.34
078_074,078,74,2,Yes.,"Therapist: ""So it seems like you've got this sort of circle of thinking in there that takes you down into a negative place, that the embarrassment kind of starts this negative spiral, takes you downward to, you're probably not consciously thinking, I'll be alone and unhappy, but somehow it's related. People will think you're stupid, they won't want to be around you.""
Patient: ""Yeah. And I feel like I, um, like not really on purpose, but like I end up doing things to like make myself not seem like kind of invisible. And then usually I don't feel like that's as rewarding when I feel engaged and involved in a group.""
Therapist: ""it kind of backfires and you probably feel more lonely and unhappy based on withdrawing and being more invisible. Definitely. And so you hold that belief of, if I do something embarrassing, it will go down that spiral, I'll be alone and unhappy, despite the fact that you told me just a couple minutes ago you had a very embarrassing experience that now has made you, has added to your repertoire as a good storyteller. It's another story you can tell.""",1172.4,1179.09
078_076,078,76,2,"No, I definitely think that you're right. I just like hearing you say that I'm a good storyteller. That's so not my experience. I don't think I'm a good storyteller. So it's hard for me just to say sure. But I agree with the evidence part.","Therapist: ""it kind of backfires and you probably feel more lonely and unhappy based on withdrawing and being more invisible. Definitely. And so you hold that belief of, if I do something embarrassing, it will go down that spiral, I'll be alone and unhappy, despite the fact that you told me just a couple minutes ago you had a very embarrassing experience that now has made you, has added to your repertoire as a good storyteller. It's another story you can tell.""
Patient: ""Yes.""
Therapist: ""So you can see that I'm questioning the evidence. And I wonder if you are questioning it too, or if you're just thinking, I better go along with this for now.""",1192.45,1209.67
079_001,079,1,4,"Yeah, this week has been a little bit difficult. I found it really hard to sleep the last few nights. I think it's because a few nights ago I had a really bad nightmare where I envisioned the lorry coming towards me and then now I avoid sleep because I don't want to be back in that state of panic.","Therapist: ""Sarah, can you give me an idea of how things have been for you since we last met?""",40.32,64.53
079_003,079,3,4,"Like I was really hot and I was like all bothered and I just didn't want to go back to sleep. I think also because I've been having quite a lot of daydreams where I'm back at the event it feels like I'm back there and I'm trapped and it's happening again. So yeah, it's been quite tough this week.","Therapist: ""Sarah, can you give me an idea of how things have been for you since we last met?""
Patient: ""Yeah, this week has been a little bit difficult. I found it really hard to sleep the last few nights. I think it's because a few nights ago I had a really bad nightmare where I envisioned the lorry coming towards me and then now I avoid sleep because I don't want to be back in that state of panic.""
Therapist: ""Right, okay. So that was last week when you had the nightmare? Yeah. And how was it when you woke up?""",72.23,95.26
079_005,079,5,2,"I think I've heard of it, but I don't know much about it.","Therapist: ""Right, okay. So that was last week when you had the nightmare? Yeah. And how was it when you woke up?""
Patient: ""Like I was really hot and I was like all bothered and I just didn't want to go back to sleep. I think also because I've been having quite a lot of daydreams where I'm back at the event it feels like I'm back there and I'm trapped and it's happening again. So yeah, it's been quite tough this week.""
Therapist: ""Yeah, so it sounds like it's been a difficult weekend. There's been quite a few nightmares, some daydreams, flashbacks in the daytime. And you've mentioned there that you've felt like you were back there. Yeah. Yeah. Okay. So it sounds like you might be experiencing what we call dissociation. Okay. Is that something that you've heard of before?""",118.83,121.1
079_007,079,7,2,It tends to happen at night when I'm asleep. I might have a nightmare and that might bring me back to being trapped in the car and being in a state of panic. But sometimes it happens when I'm at work and I'm not doing that much and my mind starts to wander a bit.,"Therapist: ""Yeah, so it sounds like it's been a difficult weekend. There's been quite a few nightmares, some daydreams, flashbacks in the daytime. And you've mentioned there that you've felt like you were back there. Yeah. Yeah. Okay. So it sounds like you might be experiencing what we call dissociation. Okay. Is that something that you've heard of before?""
Patient: ""I think I've heard of it, but I don't know much about it.""
Therapist: ""Okay. Well, dissociation is when people lose connection with the present and it can feel like they're maybe back at another time or they can feel quite disorientated or confused about where they are. Does that sound familiar? It sounds a little bit like what you were saying. Yeah, definitely. What sort of times does that happen for you then?""",144.14,166.29
079_010,079,10,1,"Of like time going by really fast? Yeah, and maybe feeling like you're on autopilot. I suppose like if you're watching a film and like you don't realise the time passing or if you're like having a really good day and it's like five o'clock and yeah.","Patient: ""It tends to happen at night when I'm asleep. I might have a nightmare and that might bring me back to being trapped in the car and being in a state of panic. But sometimes it happens when I'm at work and I'm not doing that much and my mind starts to wander a bit.""
Therapist: ""Okay, so it's happening reasonably frequently at the moment then. It sounds like it's something that's quite important for us to think about a little bit more. So maybe if I explain to you first a little bit more about what dissociation is. I think it might be easier if I jump up and do a bit of drawing on the flipboard, if that's okay. So the important thing to remember about dissociation is it's actually a really normal human experience that lots of people report experiencing to some level. So we talk about dissociation as being along a continuum. So at this end, which is dissociation that most people report,""
Therapist: ""People might talk about things like, so I was just going on autopilot and I was wondering if there's anything that you can think of maybe before your car crash that reminds you of that.""",233.66,250.63
079_016,079,16,1,"So what do you make of that so far? Yeah, I didn't realise that it existed in the autopilot example that you gave, so before trauma, so that's interesting to see it visually there.","Therapist: ""Yeah. So so it's kind of films, books can kind of read in the same thing. Yeah. Okay. Daydreaming is one as well. And the other one that comes up quite often is when people are driving maybe a journey that they've done time and time again and sort of just arrive there and don't necessarily remember all the details of their journey. Right. Yeah.""
Unknown: ""Yeah.""
Therapist: ""At this end, dissociation is really quite problematic and really interferes with people's day-to-day lives and people can find that they're not functioning very well at all. So it's a lot rarer at this end, not as many people experience it. Okay. But what happens is that when people go through traumatic experiences, so similar to the ones that we've talked about with your car crash, it pushes you up this continuum. And most people who are experiencing symptoms of PTSD tend to be around this part of this continuum. And what happens is that the types of dissociation that they experience can be quite different and the intensity and the frequency can increase as well. So you know you were talking about your nightmares and your flashbacks and some of those images that you get. Those would be the types of dissociation that you'd be experiencing. So I'll just pop those on here.""",349.09,367.31
079_019,079,19,2,"Yeah, I have a throw on my bed, which is really soft. So maybe that could be a good thing to touch to remind me that, you know, I'm in a safe place in my bedroom. That's a really...","Patient: ""So what do you make of that so far? Yeah, I didn't realise that it existed in the autopilot example that you gave, so before trauma, so that's interesting to see it visually there.""
Therapist: ""Yeah, so it's really normal, but it's just that you've crept up this continuum a bit really. So it sounds like your nightmares and your flashbacks and your memories are causing you some difficulties at the moment, so I suppose it makes sense for us to maybe think about how we can help you come down this continuum a little bit. So one of the main ways that One of the main things that we do with regards to dissociation is we use something called grounding. Okay. So grounding techniques kind of do what they say on the tin really. It's about grounding you in the present moment. Suppose it's like keeping two feet on the ground because when people dissociate they lose that connection with the here and now and can kind of become quite disorientated. So grounding is kind of the opposite of that and helping you to stay present in the moment. Okay. Okay so there's lots of different ways of using grounding but some of the people I've worked with in the past have found it quite useful to think about it in terms of the five senses and just means that you we can give you lots of different options to try then so I'm just going to kind of draw a quick table up and up on here.""
Therapist: ""Okay, so we've got touch, taste, smell, sight and hearing. So maybe if we take the example of your nightmares and we can think through some of the things that you could do to help ground yourself in the present moment when you come to from a nightmare. Okay. So where do you want to start? Maybe touch. Yeah, touch is fine. Okay, so thinking about when you wake up from a nightmare then, where are you usually? In my bed, yeah, in my bedroom. Okay. Yeah. So is there anything that's around you in your bedroom that might help remind you where you are?""",500.18,514.81
079_021,079,21,1,"I could keep something next to my bed, like a mint or something. Yeah? Yeah. Great. And what about smell? I suppose my room smells a bit like perfume or like if I've lit a candle, it's kind of got a homely smell about it.","Therapist: ""Okay, so we've got touch, taste, smell, sight and hearing. So maybe if we take the example of your nightmares and we can think through some of the things that you could do to help ground yourself in the present moment when you come to from a nightmare. Okay. So where do you want to start? Maybe touch. Yeah, touch is fine. Okay, so thinking about when you wake up from a nightmare then, where are you usually? In my bed, yeah, in my bedroom. Okay. Yeah. So is there anything that's around you in your bedroom that might help remind you where you are?""
Patient: ""Yeah, I have a throw on my bed, which is really soft. So maybe that could be a good thing to touch to remind me that, you know, I'm in a safe place in my bedroom. That's a really...""
Therapist: ""Yeah, it's a really good example and it also sounds like that's quite comforting to you as well, which is really important. Okay, so it's a great example. What do you think for taste? The trickier one.""",528.75,554.46
079_024,079,24,2,Maybe I have some photos in my room which might remind me of loved ones or fun things that I've done.,"Patient: ""I could keep something next to my bed, like a mint or something. Yeah? Yeah. Great. And what about smell? I suppose my room smells a bit like perfume or like if I've lit a candle, it's kind of got a homely smell about it.""
Therapist: ""That sounds quite soothing as well, I guess similar to the throw example you gave. Okay, let's pop those on.""
Therapist: ""Maybe one thing just to mention about the perfume is that when we're thinking about grounding techniques, it can be really, really helpful to think about things that have happened since the crash or that you don't associate with the crash, because the last thing we want to do is to be kind of you know, kind of feeding into those memories. They want it to be something that's quite separate. So it just made me think when you said perfume that it might not be, might be a better idea to smell a perfume which you weren't wearing at the time of the crash, for example, or maybe one that you've bought since. Okay, cool. That makes sense, yeah. What about sight?""",609.38,620.53
079_026,079,26,1,It's usually quite quiet in my bedroom except for maybe my partner's snoring or breathing.,"Therapist: ""Maybe one thing just to mention about the perfume is that when we're thinking about grounding techniques, it can be really, really helpful to think about things that have happened since the crash or that you don't associate with the crash, because the last thing we want to do is to be kind of you know, kind of feeding into those memories. They want it to be something that's quite separate. So it just made me think when you said perfume that it might not be, might be a better idea to smell a perfume which you weren't wearing at the time of the crash, for example, or maybe one that you've bought since. Okay, cool. That makes sense, yeah. What about sight?""
Patient: ""Maybe I have some photos in my room which might remind me of loved ones or fun things that I've done.""
Therapist: ""What about this one, hearing?""",624.17,634.28
079_029,079,29,3,Well at night it would be really useful because a lot of those things are to do with my bedroom but also I suppose if I was at work and I was having a daydream then I could just have some or if I was in the car with my partner and I was getting in a panic I could just have some mints nearby and maybe that would give me a strong taste of something that I didn't have when I was in the car and the lorry was coming towards me.,"Patient: ""It's usually quite quiet in my bedroom except for maybe my partner's snoring or breathing.""
Therapist: ""Yeah, that's a good example.""
Therapist: ""Yeah, so your partner snoring and remind me, were you on your own in the crash? Yeah. Yeah, so that actually, that's a really good one because maybe if you were able to listen to your partner snoring, it might also remind you not only where you are, but also that you're not on your own as well. So that could be quite a useful one. Okay. So we've got some questions. really good examples here. So when do you think you could use this or when do you think this might be useful to use this approach?""",673.62,704.94
079_031,079,31,1,"Yeah, I think it could be useful. I'm willing to, you know, obviously try whatever I can with the photos. Could I use photos on my phone? Like if obviously I'm not in my room,","Therapist: ""Yeah, so your partner snoring and remind me, were you on your own in the crash? Yeah. Yeah, so that actually, that's a really good one because maybe if you were able to listen to your partner snoring, it might also remind you not only where you are, but also that you're not on your own as well. So that could be quite a useful one. Okay. So we've got some questions. really good examples here. So when do you think you could use this or when do you think this might be useful to use this approach?""
Patient: ""Well at night it would be really useful because a lot of those things are to do with my bedroom but also I suppose if I was at work and I was having a daydream then I could just have some or if I was in the car with my partner and I was getting in a panic I could just have some mints nearby and maybe that would give me a strong taste of something that I didn't have when I was in the car and the lorry was coming towards me.""
Therapist: ""Yeah, so again, it's about reminding yourself where you are and really emphasising what's different about that situation. Yeah, great. So, yeah, we've got lots of different options, really, because for that reason, you know, if you're in the car going somewhere, maybe with a family member or something, you know, it's likely that your partner's going to be with you snoring. You might well be. But, yes, it's good to have some different options. So... So the idea isn't that you try all of these at once, it's more about you going away and trying some things out and working out what works for you, and then you can carry on using the ones that fit for you. Okay. Okay. So have you got any questions about any of that, or any feedback on how that was, looking at that?""",757.0,770.69
080_001,080,1,4,"Yeah, yeah, they're popping up a little bit more than... that makes me comfortable.","Therapist: ""Okay, Kate, so just to kind of recap our conversation so far, it sounds as though your mood has been kind of lower than it has been over the past several weeks, and that those thoughts of suicide are kind of showing up again a little bit more than we're both comfortable with. Is that accurate?""",18.31,22.46
080_007,080,7,2,"Over this last week, Probably a bit lower, yeah, maybe around like a four or five.","Therapist: ""How does that feel to you?""
Patient: ""Yeah, I think that's probably a good idea.""
Therapist: ""Okay, all right. So what we'll just do is go through a few things here. At the end of that, we'll kind of take those next steps, okay? Okay. So the first thing we're going to talk about is your mood, your affect. So remember when we do that scaling, one means you're feeling really, really low. Ten means you're feeling basically awesome, you know, best you've ever felt. I know last week you were at about a six or seven. Where would you say you are now?""",84.41,89.6
080_009,080,9,4,"Sometimes, but when it goes up a bit, it doesn't seem to last as long, so then, you know, I'd say, It's dipped to a bit of a three, but it's hovering right around that four or five for the most as an average.","Therapist: ""Okay, all right. So what we'll just do is go through a few things here. At the end of that, we'll kind of take those next steps, okay? Okay. So the first thing we're going to talk about is your mood, your affect. So remember when we do that scaling, one means you're feeling really, really low. Ten means you're feeling basically awesome, you know, best you've ever felt. I know last week you were at about a six or seven. Where would you say you are now?""
Patient: ""Over this last week, Probably a bit lower, yeah, maybe around like a four or five.""
Therapist: ""A four or five, right, okay, okay. And has that been kind of average? Are there any times when that inches up a bit, feeling a little better, or kind of tanks out, goes a little lower?""",98.24,110.29
080_011,080,11,2,"Really kind of like lonely a little. Yeah. A little sad. Well, a lot sad, I guess. I don't know. I kind of just feel like","Therapist: ""A four or five, right, okay, okay. And has that been kind of average? Are there any times when that inches up a bit, feeling a little better, or kind of tanks out, goes a little lower?""
Patient: ""Sometimes, but when it goes up a bit, it doesn't seem to last as long, so then, you know, I'd say, It's dipped to a bit of a three, but it's hovering right around that four or five for the most as an average.""
Therapist: ""Yeah, and that's pretty low, isn't it? Yeah. Would you be able to kind of name any specific emotions within that that you've been feeling?""",119.62,128.95
080_013,080,13,2,"They're definitely popping up more frequently than I'm comfortable with, more frequently than I'm maybe used to recently, even today. you know, I was coming here and a thought popped into my head.","Therapist: ""Yeah, and that's pretty low, isn't it? Yeah. Would you be able to kind of name any specific emotions within that that you've been feeling?""
Patient: ""Really kind of like lonely a little. Yeah. A little sad. Well, a lot sad, I guess. I don't know. I kind of just feel like""
Therapist: ""What's the point? Maybe we can call it a little bit hopeless. Is that how it shows up? Yeah. I think that hopelessness is there. It's kind of there. Yeah. Okay. So that's certainly something that we see when those suicidal thoughts start showing up a bit more. Often it's linked or kind of that one comes before the other, chicken or the egg kind of thing, mood and those hopeless thoughts kind of go together. Okay. So, can we talk a little bit about those suicidal thoughts themselves? How often, how frequently do you think these days are they showing up for you? Even today, you know, how frequently are they showing up?""",166.99,180.66
080_015,080,15,5,"It was just kind of more of that, like, what's the point sort of thinking and, you know, like if it's not going to get better, why bother going through all of this? So just sort of like, you know, how could I kind of end that if I wanted to, or if, you know, if I, if it really started getting to that point.","Therapist: ""What's the point? Maybe we can call it a little bit hopeless. Is that how it shows up? Yeah. I think that hopelessness is there. It's kind of there. Yeah. Okay. So that's certainly something that we see when those suicidal thoughts start showing up a bit more. Often it's linked or kind of that one comes before the other, chicken or the egg kind of thing, mood and those hopeless thoughts kind of go together. Okay. So, can we talk a little bit about those suicidal thoughts themselves? How often, how frequently do you think these days are they showing up for you? Even today, you know, how frequently are they showing up?""
Patient: ""They're definitely popping up more frequently than I'm comfortable with, more frequently than I'm maybe used to recently, even today. you know, I was coming here and a thought popped into my head.""
Therapist: ""Okay. Yeah. Okay. All right. And what was that thought?""",184.88,205.51
080_017,080,17,3,"Probably once a day. Once a day, if on the higher end, maybe twice a day. Um, sometimes it's fleeting and they just kind of pass through and I, and I try not to give it, you know, any weight, but sometimes it's harder to shake it off. Of course. Yeah. Yeah.","Therapist: ""Okay. Yeah. Okay. All right. And what was that thought?""
Patient: ""It was just kind of more of that, like, what's the point sort of thinking and, you know, like if it's not going to get better, why bother going through all of this? So just sort of like, you know, how could I kind of end that if I wanted to, or if, you know, if I, if it really started getting to that point.""
Therapist: ""A lot of those hopeless, what's the point? Why bother? Why am I working so hard at this? Would you say you're having those every hour, multiple times throughout the hour, a couple times a day? How are you feeling?""",219.41,237.75
080_021,080,21,1,"I'd probably say the strongest it's gotten maybe would be like somewhere around a 6 or a 7. A 6 or a 7, okay. And then when they're fleeting, it's more like maybe like a 5. A 5, okay.","Therapist: ""Okay. So once or twice a day, sometimes fleeting other times, does it last for an hour that that kind of sits in your mind?""
Patient: ""It can.""
Therapist: ""Okay. It can. Yeah. Okay. And when those thoughts show up, I know it's kind of a weird question, but how strong would you say they are? You know, 10 meaning I can't, it's so strong I can't hardly not do it. Right. One meaning, ugh, just, no, not, you know, kind of something that whizzes by. Right. How strong would you say they are?""",263.17,273.56
080_023,080,23,4,"Yeah, I guess sometimes, I guess it's, I don't know, I don't know if it's necessarily a plan, but I have these like ideas or images of like this kind of like wading out into like a lake. Into a lake, okay. Yeah, and just sort of walking and like I kind of picture myself maybe being just submerged under the water and not resurfacing.","Therapist: ""Okay. It can. Yeah. Okay. And when those thoughts show up, I know it's kind of a weird question, but how strong would you say they are? You know, 10 meaning I can't, it's so strong I can't hardly not do it. Right. One meaning, ugh, just, no, not, you know, kind of something that whizzes by. Right. How strong would you say they are?""
Patient: ""I'd probably say the strongest it's gotten maybe would be like somewhere around a 6 or a 7. A 6 or a 7, okay. And then when they're fleeting, it's more like maybe like a 5. A 5, okay.""
Therapist: ""So once or twice a day, as high as a seven, but more kind of that in the middle, about a five. Yeah. Okay. All right. Okay. And so those thoughts that you were having on the way here, kind of those hopeless thoughts, why bother kind of stuff. If those, you know, if suicide kind of comes up more for you, do you have a plan? Would you have sort of some idea of how you'd want to complete suicide or do that?""",302.29,323.61
080_025,080,25,1,"Not really. I guess in an image-wise it's sort of like my family cottage link, kind of where I kind of grew up, but it's kind of the only imagery I really... The only one that you've got, yeah. And is that close by or three or four hours away? No, it's like four hours away. Four hours away. Yeah, so it's pretty far. But it's just, I guess, a maybe serene place in my mind, so it kind of... It feels like that weight would be lifted kind of there.","Therapist: ""So once or twice a day, as high as a seven, but more kind of that in the middle, about a five. Yeah. Okay. All right. Okay. And so those thoughts that you were having on the way here, kind of those hopeless thoughts, why bother kind of stuff. If those, you know, if suicide kind of comes up more for you, do you have a plan? Would you have sort of some idea of how you'd want to complete suicide or do that?""
Patient: ""Yeah, I guess sometimes, I guess it's, I don't know, I don't know if it's necessarily a plan, but I have these like ideas or images of like this kind of like wading out into like a lake. Into a lake, okay. Yeah, and just sort of walking and like I kind of picture myself maybe being just submerged under the water and not resurfacing.""
Therapist: ""Right, okay, so the plan would be to kind of find a, do you have a lake in mind or...""",328.85,354.73
080_027,080,27,1,"Yeah, and I think that probably feels nice inside.","Therapist: ""Right, okay, so the plan would be to kind of find a, do you have a lake in mind or...""
Patient: ""Not really. I guess in an image-wise it's sort of like my family cottage link, kind of where I kind of grew up, but it's kind of the only imagery I really... The only one that you've got, yeah. And is that close by or three or four hours away? No, it's like four hours away. Four hours away. Yeah, so it's pretty far. But it's just, I guess, a maybe serene place in my mind, so it kind of... It feels like that weight would be lifted kind of there.""
Therapist: ""Almost sounds kind of calming and peaceful.""",357.15,362.04
080_029,080,29,1,"No, I mean, I've, Again, I think you've used that term passive before, so I think like I've had maybe more passive thoughts when things have been tough.","Therapist: ""Almost sounds kind of calming and peaceful.""
Patient: ""Yeah, and I think that probably feels nice inside.""
Therapist: ""I'm going to take note of that because I wonder as we work our way through this if that's an important piece for us to pay attention to. You're in so much pain right now. and it's it's sounding like oh you just want some serenity some peacefulness out of all of this and sometimes these thoughts kind of spiral into the negativity into the into these suicidal thoughts maybe i can find that if i walk out to the lake yeah absolutely okay okay so i'm just going to take note of that so the kind of the lake the cottage but that's four or five hours away right yeah And just remind me, I know we talked about this in our first session, but have you had any previous suicide attempts before? No. You haven't? No. Okay.""",404.27,411.95
080_033,080,33,1,"I don't drink too often. I mean, I have some wine every once in a while, but...","Therapist: ""Right.""
Patient: ""But nothing like this.""
Therapist: ""Okay. Okay. All right. Some of the times before. No. And we've talked, I'm just going to confirm this, we talked before in our previous assessment, you're not using street drugs or marijuana or things like that. No. How much are you drinking these days?""",427.31,432.44
080_035,080,35,1,Maybe like one or two glasses every couple nights.,"Therapist: ""Okay. Okay. All right. Some of the times before. No. And we've talked, I'm just going to confirm this, we talked before in our previous assessment, you're not using street drugs or marijuana or things like that. No. How much are you drinking these days?""
Patient: ""I don't drink too often. I mean, I have some wine every once in a while, but...""
Therapist: ""What's once in a while, what would you say? I would just want to specify, sort of this week, these days, how much would you be having?""",442.16,445.28
080_037,080,37,2,"Well, I guess, I don't know, I'm usually alone when I'm drinking the wine, so that kind of makes it a little bit harder. so i don't know i guess i feel more lonely okay okay more lonely and not yeah i don't have anybody to share it with so i guess that kind of compounds it i guess yeah okay okay um anything kind of that is on your calendar coming up that you're looking forward to oh Yeah, in a couple of weeks actually. I have my nephew's baptism. Oh, okay.","Therapist: ""What's once in a while, what would you say? I would just want to specify, sort of this week, these days, how much would you be having?""
Patient: ""Maybe like one or two glasses every couple nights.""
Therapist: ""Okay, okay. Do you find that when you're having a glass of wine, what happens to those thoughts?""",453.55,489.58
080_039,080,39,2,"I feel good because my sister will be coming and all the kids will be there, my family will all be together. I get a little anxious because I won't have a partner there, but I have all the kids there. All my four nephews and my one niece will be there. It'll be a lot of fun, and it's going to be really nice to feel in my community, I guess. Wow.","Therapist: ""Okay, okay. Do you find that when you're having a glass of wine, what happens to those thoughts?""
Patient: ""Well, I guess, I don't know, I'm usually alone when I'm drinking the wine, so that kind of makes it a little bit harder. so i don't know i guess i feel more lonely okay okay more lonely and not yeah i don't have anybody to share it with so i guess that kind of compounds it i guess yeah okay okay um anything kind of that is on your calendar coming up that you're looking forward to oh Yeah, in a couple of weeks actually. I have my nephew's baptism. Oh, okay.""
Therapist: ""When you think about that, how does that make you feel?""",492.28,514.71
080_041,080,41,2,"I kind of guess I forget that that's coming, because it's not often my sister comes down, so it's not often we all get together. I kind of forget that's happening.","Therapist: ""When you think about that, how does that make you feel?""
Patient: ""I feel good because my sister will be coming and all the kids will be there, my family will all be together. I get a little anxious because I won't have a partner there, but I have all the kids there. All my four nephews and my one niece will be there. It'll be a lot of fun, and it's going to be really nice to feel in my community, I guess. Wow.""
Therapist: ""Yeah. When you talk about that, you kind of light up a little bit.""",517.82,526.68
080_043,080,43,2,"Yeah, I guess in the summer there's going to be some more family things that, again, give me a little bit of anxiety. Family things can be hard because I am on my own, but I know, again, when the kids are there, I'm kind of distracted from that. full of all that joy those little ones bring. Oh, that's fantastic. Yeah, I guess there'll be one event in the summer. Okay, great. Wonderful.","Therapist: ""Yeah. When you talk about that, you kind of light up a little bit.""
Patient: ""I kind of guess I forget that that's coming, because it's not often my sister comes down, so it's not often we all get together. I kind of forget that's happening.""
Therapist: ""Right. Is there anything else that you could look forward to?""",530.86,553.95
080_045,080,45,2,"Definitely my nephews and nieces and my sisters and my mom. I think my family would it would be devastating to them. I don't think they'd quite understand it. So I would feel pretty horrible about putting them through that. And there's a lot I want to be around to see, you know, yeah, they're all starting school soon and there's going to be some exciting stuff family wise coming out. So that'll be really, that'd be really cool to be part of that. Yeah, definitely. And things, you know, at work, they're not going great, but I, I'm hoping there'll be some change coming up, so that could be, if things turn around at work, that could be something that would be exciting again.","Therapist: ""Right. Is there anything else that you could look forward to?""
Patient: ""Yeah, I guess in the summer there's going to be some more family things that, again, give me a little bit of anxiety. Family things can be hard because I am on my own, but I know, again, when the kids are there, I'm kind of distracted from that. full of all that joy those little ones bring. Oh, that's fantastic. Yeah, I guess there'll be one event in the summer. Okay, great. Wonderful.""
Therapist: ""So that baptism is coming up in a couple of weeks, and then the summer has some more exciting things coming. Yeah. Fantastic. Okay. Okay. And again, we've sort of talked about a few of these things, but if you could think of kind of reasons not to go up to the lake and to sort of wade out there and float to the bottom of it, what would be some reasons to not do that?""",576.65,619.63
080_047,080,47,4,"I mean, that would be amazing. It would be really great. And there are, there are definitely those flashes of like, you know, what if, what if this does all turn around, you know? And, and I guess I'm, I try to hold onto those. It's hard. It seems to slip through my fingers. Those, those thoughts seem to be harder to hold onto. Um, And then, of course, when I'm feeling down. But, yeah, I mean, yeah. I mean, things could change. They could change around.","Therapist: ""So that baptism is coming up in a couple of weeks, and then the summer has some more exciting things coming. Yeah. Fantastic. Okay. Okay. And again, we've sort of talked about a few of these things, but if you could think of kind of reasons not to go up to the lake and to sort of wade out there and float to the bottom of it, what would be some reasons to not do that?""
Patient: ""Definitely my nephews and nieces and my sisters and my mom. I think my family would it would be devastating to them. I don't think they'd quite understand it. So I would feel pretty horrible about putting them through that. And there's a lot I want to be around to see, you know, yeah, they're all starting school soon and there's going to be some exciting stuff family wise coming out. So that'll be really, that'd be really cool to be part of that. Yeah, definitely. And things, you know, at work, they're not going great, but I, I'm hoping there'll be some change coming up, so that could be, if things turn around at work, that could be something that would be exciting again.""
Therapist: ""And that's an interesting kind of idea that you just said, if things turn around at work and things like that. Do you feel as though, kind of looking at your life, you'd have some ability to turn things around at work, for example, or you've mentioned several times that you don't have a partner right now. Do you feel as though, you know, maybe if a few, you know, we've work together to lighten your mood a bit and some stuff like that, that there could be a chance that you'd have some control to find a partner to do these things. Yeah.""",648.07,674.6
080_049,080,49,1,"Yeah, I think that sounds good. Okay. I think it'll be helpful to you to have that list because then I know kind of it's there and I don't have to think about it.","Therapist: ""And that's an interesting kind of idea that you just said, if things turn around at work and things like that. Do you feel as though, kind of looking at your life, you'd have some ability to turn things around at work, for example, or you've mentioned several times that you don't have a partner right now. Do you feel as though, you know, maybe if a few, you know, we've work together to lighten your mood a bit and some stuff like that, that there could be a chance that you'd have some control to find a partner to do these things. Yeah.""
Patient: ""I mean, that would be amazing. It would be really great. And there are, there are definitely those flashes of like, you know, what if, what if this does all turn around, you know? And, and I guess I'm, I try to hold onto those. It's hard. It seems to slip through my fingers. Those, those thoughts seem to be harder to hold onto. Um, And then, of course, when I'm feeling down. But, yeah, I mean, yeah. I mean, things could change. They could change around.""
Therapist: ""They could change. Okay, great. Okay Kate, well thank you for going through this with me. Just to kind of recap, so the mood definitely is lower than it has been and those thoughts are around one or two times a day and they can get as strong as a seven. There's a bit of this kind of idea that you drive to the lake and just sort of head out there until, you know, sinking to the bottom where it's peaceful and calm. So those are all kind of things that in my kind of clinical mind would be little red flags, you know, and the more kind of I hear about that, the more the more my alarm bells go off. However, on the other side here, you know, you haven't had a previous suicide attempt. You're not using substances right now. One or two glasses of wine that we just want to think about because it sounds like that is a time when maybe your mood goes a little lower because of those thoughts of loneliness. Maybe we want to target that. um but you've got some really exciting things to look forward to you've got quite a few reasons to live pretty significant ones right yeah and and there's a little bit of a sense that things could turn around so when i'm kind of putting it all through my clinical kind of thinking i'd say that we're not we don't need to call the the you know, the hospital today, or even maybe your mom and dad, although it might be helpful if we kind of call them. What I think might be useful today, if you're kind of willing to do this with me, would be to create a safety plan. So that that might involve, you know, putting some really good structured schedule activities in place so you know what kind of is coming up over the next days and especially the weekend when it's probably more open and that's a more difficult time. Maybe we put some names and phone numbers down for people you can call to and connect with when you are feeling a little lower. Certainly I'll give you the city's emergency numbers and so you know what crisis numbers to call and things like that. And then maybe even do a little bit more work about journaling or writing about some of these exciting things that are coming up for you. Yeah. So that we can, you know, really kind of build on that. And then, of course, moving into our therapy session after that. Does that sound okay?""",802.76,810.01
081_001,081,1,2,"Um, well, I'm just, you know, I waved, I saw this on me and just kind of looked away or, you know, so I'm thinking, yeah, they don't like me. They're kind of a jerk, you know, that kind of stuff.","Therapist: ""Okay Brett, so we've got this situation where you were walking down the street the other day and you saw a friend of yours across the street and they didn't acknowledge you. They didn't wave or even look at you from across the street, right? And we've kind of identified this thought or this assumption here that they don't like me, right? So I thought we'd maybe do a little bit of kind of a dialogue back and forth. I could ask you some questions about wondering this, about this a little bit. This is called Socratic questioning. Is that okay if we move into this? Sure, sure. Okay. So kind of in relation to this idea here, this situation, and we kind of named this already that you think the other person's point of view is they don't like you. Is that right? Do you want to round that out anymore or what else they might be thinking?""",48.45,63.13
081_005,081,5,2,I guess I'm assuming because they didn't acknowledge me that they don't like me. Sure. I guess that's an assumption. Right.,"Therapist: ""Right, right. So kind of one about you, they don't like me or they don't like you. Another one about them, they're kind of a jerk. Yeah. Right. Which one feels a little bit stronger should we think about right now? Or both?""
Patient: ""They don't like me. They don't like me.""
Therapist: ""Kind of focus on that one. Okay. All right. So if you think about that, that idea in your mind, they don't like me, Are you making any assumptions or are there any assumptions kind of running in the background of that?""",93.9,102.09
081_009,081,9,4,Okay. Anything else? I guess I'm assuming they saw me. Yeah.,"Therapist: ""So kind of a link that acknowledging you would mean they like you and not acknowledging you would mean they don't like you.""
Patient: ""Right.""
Therapist: ""Right.""",108.5,114.81
081_013,081,13,1,I guess I'm assuming that wasn't the case. Right. Yeah. Good point.,"Therapist: ""Even though I think they did, you know, I guess I can't be 100% sure. Big assumption there that they actually saw you.""
Patient: ""Yeah.""
Therapist: ""And could there even be an assumption that, or maybe this has happened to you, you see someone across the street, but you don't really know who they are. Maybe they saw you, but even didn't recognize you. Could that have been the case?""",133.93,140.32
081_015,081,15,2,"Well, I think the evidence would be the lack of acknowledgement. I think that would be evidence that they don't like me. I don't know. I guess other times? Do you mean like at other points where they... I don't know. I think sometimes they can be a little cold towards me, I think. Yeah. So that makes me think that they don't like me. Sure. Yeah. They don't go out of their way to include me in things. Okay.","Therapist: ""And could there even be an assumption that, or maybe this has happened to you, you see someone across the street, but you don't really know who they are. Maybe they saw you, but even didn't recognize you. Could that have been the case?""
Patient: ""I guess I'm assuming that wasn't the case. Right. Yeah. Good point.""
Therapist: ""Okay. Okay. So a couple of assumptions here. One assumption that you named that acknowledgement means liking and then vice versa. The assumption that they saw you in the first place. The assumption also that they recognized you. Right. Right. Yeah. A couple of things there. Okay. So based on those assumptions, we've got this conclusion they don't like you. Do you have any kind of proof or evidence that would suggest they don't like you?""",168.75,203.22
081_019,081,19,4,"Oh, I hope. I mean. I hope it's not. I hope it's not true, but it just seems the evidence points to that.","Therapist: ""So there's a couple of pieces there, right?""
Patient: ""Yeah.""
Therapist: ""And so, you know, you're walking down the street, they didn't see you. These things happen and you just think, you know, oh yeah, they don't like me. Yeah. Yeah. Why do you think that's the conclusion you settled on? Is that the best one?""",221.35,229.73
081_021,081,21,2,"I've got to change the way I look at it. Yeah, you've got to change the way you look at it. Um, I guess they could have been distracted, busy. Sure. Stressed out. Yeah. Yeah. Those could be other conclusions as well. Sure. Stressed, distracted, busy. Right. Um, I don't know. What are their explanations for that?","Therapist: ""And so, you know, you're walking down the street, they didn't see you. These things happen and you just think, you know, oh yeah, they don't like me. Yeah. Yeah. Why do you think that's the conclusion you settled on? Is that the best one?""
Patient: ""Oh, I hope. I mean. I hope it's not. I hope it's not true, but it just seems the evidence points to that.""
Therapist: ""Okay, but given what we've talked about, our assumptions and these pieces of evidence, are there other viewpoints or other conclusions that you could have settled on?""",245.31,274.6
081_023,081,23,2,I guess it's possible. I can't say it's not possible. It takes looking at it in an entirely different way.,"Therapist: ""Okay, but given what we've talked about, our assumptions and these pieces of evidence, are there other viewpoints or other conclusions that you could have settled on?""
Patient: ""I've got to change the way I look at it. Yeah, you've got to change the way you look at it. Um, I guess they could have been distracted, busy. Sure. Stressed out. Yeah. Yeah. Those could be other conclusions as well. Sure. Stressed, distracted, busy. Right. Um, I don't know. What are their explanations for that?""
Therapist: ""Right. Okay, and so those are, you know, we kind of talk about hypotheses or these thoughts we've got, right? One thought is, they don't like me, based on these things. And that's the one you hung on to. Yeah. Why do you suppose you rejected these other ones? They're busy, they didn't see me, they're stressed out. I didn't think of them. You didn't think of them? No. Okay. But now, you're thinking of them now, what do you think of them now?""",299.55,311.18
081_025,081,25,2,"The fear, anxiety, all those things.","Therapist: ""Right. Okay, and so those are, you know, we kind of talk about hypotheses or these thoughts we've got, right? One thought is, they don't like me, based on these things. And that's the one you hung on to. Yeah. Why do you suppose you rejected these other ones? They're busy, they didn't see me, they're stressed out. I didn't think of them. You didn't think of them? No. Okay. But now, you're thinking of them now, what do you think of them now?""
Patient: ""I guess it's possible. I can't say it's not possible. It takes looking at it in an entirely different way.""
Therapist: ""Let's go back to that first one, they don't like me. When that goes through your mind or you kind of hang on to that one, what's the result?""",329.43,333.11
081_027,081,27,2,"Well, if that was true, then I would not be depressed. I would just say whatever, you know. They were busy. They were busy, right.","Therapist: ""Let's go back to that first one, they don't like me. When that goes through your mind or you kind of hang on to that one, what's the result?""
Patient: ""The fear, anxiety, all those things.""
Therapist: ""Sure, okay. And then we've got these other possibilities, right? They were stressed, they didn't see me, didn't recognize that. What would be the implications of latching onto those or taking those on?""",345.29,356.87
081_029,081,29,2,"Yeah, it's different. It's forcing me to look at things differently.","Therapist: ""Sure, okay. And then we've got these other possibilities, right? They were stressed, they didn't see me, didn't recognize that. What would be the implications of latching onto those or taking those on?""
Patient: ""Well, if that was true, then I would not be depressed. I would just say whatever, you know. They were busy. They were busy, right.""
Therapist: ""What's it like to kind of have a conversation like this?""",360.73,368.84
081_031,081,31,4,"Intrigued a little bit. Intrigued. And a little bit, like, surprised. Like how, you know. how come I didn't think of these things? You know what I mean? Like I just immediately took for granted the belief that they rejected me. You know, and I, you know, I still kind of think, I still think that's true, but this is causing me to doubt it a little bit, you know, doubt the certainty of that conclusion.","Therapist: ""What's it like to kind of have a conversation like this?""
Patient: ""Yeah, it's different. It's forcing me to look at things differently.""
Therapist: ""And now that we are looking at things differently, how does that make you feel emotionally?""",377.21,402.96
082_001,082,1,2,"The whiteboard, the table, blanket, my coffee, and the picture.","Therapist: ""okay Kate so I know that sometimes you struggle with having really intense emotions and right now I know that I'm kind of reading your face and your body language and it's a time even in this moment of feeling some pretty intense and strong emotions and so I'm wondering if it would be okay with you if I could show you a technique called a grounding technique grounding is something we do when we are feeling a big rush of emotion or when we're feeling that kind of of lack of emotion, when we're kind of numbing out. And what grounding does is it asks us and requires us to kind of focus outside of ourselves. When we have big strong emotions, often we kind of internalize, turn inward, and that seems to kind of perpetuate things and make it worse. Whereas if we turn outward, and ground in our environment, ground with our senses, ground with what's around us, that can help bring us out of it and help us feel a little bit more rooted in the current moment. So is that all right if I show you this technique and we can kind of teach it to you but also we'll experience it together. Is that okay? Yeah. All right. So this technique is called 5-4-3-2-1. It's very simple and you can use it anywhere. And we're just going to use the senses of sight and sound and touch or feel to ground. So could we just go into it? Sure. So let's just take a quick moment to take a breath and just kind of center ourselves in this moment. I just want you to keep your eyes open. Okay. Just start with looking around the room. Just name five things that you can see.""",102.85,115.78
082_003,082,3,2,The ticking clock. You can hear kind of my own breathing. Sounds like an air conditioner or something. And then the sound machine. Sound machine. And one more.,"Therapist: ""okay Kate so I know that sometimes you struggle with having really intense emotions and right now I know that I'm kind of reading your face and your body language and it's a time even in this moment of feeling some pretty intense and strong emotions and so I'm wondering if it would be okay with you if I could show you a technique called a grounding technique grounding is something we do when we are feeling a big rush of emotion or when we're feeling that kind of of lack of emotion, when we're kind of numbing out. And what grounding does is it asks us and requires us to kind of focus outside of ourselves. When we have big strong emotions, often we kind of internalize, turn inward, and that seems to kind of perpetuate things and make it worse. Whereas if we turn outward, and ground in our environment, ground with our senses, ground with what's around us, that can help bring us out of it and help us feel a little bit more rooted in the current moment. So is that all right if I show you this technique and we can kind of teach it to you but also we'll experience it together. Is that okay? Yeah. All right. So this technique is called 5-4-3-2-1. It's very simple and you can use it anywhere. And we're just going to use the senses of sight and sound and touch or feel to ground. So could we just go into it? Sure. So let's just take a quick moment to take a breath and just kind of center ourselves in this moment. I just want you to keep your eyes open. Okay. Just start with looking around the room. Just name five things that you can see.""
Patient: ""The whiteboard, the table, blanket, my coffee, and the picture.""
Therapist: ""Okay. And now turning to your sense of hearing, what are five things you can hear?""",122.47,137.51
082_006,082,6,1,"My hair is kind of wet still. I can feel the couch. Oh, my necklace.","Patient: ""The ticking clock. You can hear kind of my own breathing. Sounds like an air conditioner or something. And then the sound machine. Sound machine. And one more.""
Patient: ""My thoughts? Sure.""
Therapist: ""Okay. And then turning to your sense of touch or feeling. What are five things you can feel right now? This pillow.""",157.02,169.26
082_008,082,8,1,"The whiteboard, my coffee, the picture, and the blanket.","Therapist: ""Okay. And then turning to your sense of touch or feeling. What are five things you can feel right now? This pillow.""
Patient: ""My hair is kind of wet still. I can feel the couch. Oh, my necklace.""
Therapist: ""And my elbow. And now think of four things that you can see and you can repeat them. Okay.""",181.7,189.19
082_010,082,10,1,"The clock, the air conditioner, and the sound machine, and then my breathing and talking.","Therapist: ""And my elbow. And now think of four things that you can see and you can repeat them. Okay.""
Patient: ""The whiteboard, my coffee, the picture, and the blanket.""
Therapist: ""Excellent. And four things that you can hear.""",192.17,202.91
082_012,082,12,1,"This pillow. Yeah. And the couch. Definitely my necklace, and then my hair again.","Therapist: ""Excellent. And four things that you can hear.""
Patient: ""The clock, the air conditioner, and the sound machine, and then my breathing and talking.""
Therapist: ""Okay. And four things that you can feel with your sense of touch.""",206.62,215.54
082_016,082,16,1,"Okay. Well, I like looking at the picture, and the blanket, and the whiteboard.","Therapist: ""Okay. And now, three things that you can see. You can repeat.""
Patient: ""I can repeat them?""
Therapist: ""Yeah.""",220.27,226.14
082_018,082,18,1,"And three things that you can hear? The clock. And then, again, my talking, and then the sound machine. Right. And three things that you can touch with your sense of feeling. This pillow, and my necklace, and the couch.","Therapist: ""Yeah.""
Patient: ""Okay. Well, I like looking at the picture, and the blanket, and the whiteboard.""
Therapist: ""Okay.""",226.44,244.0
082_024,082,24,1,I definitely feel more relaxed. I don't feel in my head as much. Yeah. Okay.,"Therapist: ""Alright. How do you feel now?""
Patient: ""I feel better. Yeah? Yeah.""
Therapist: ""How do you feel now as compared to when we started?""",281.38,286.11
083_001,083,1,4,"Well, I'm working full-time. I'm a part-time student. I've just gotten engaged and I live at home. There's just so much stress in my life. I have everything happening all at once. Just to top it all off, I failed an exam, a really big exam, and I just feel like I can't do anything anymore. I can't do anything right. I've just got so much stress and I feel like such a disappointment, such a failure. I've embarrassed my family by failing. I just don't know what to do anymore. I guess I've come here today to tell you I want to leave uni. I guess that's why I've come here to you today.","Therapist: ""Okay, Masha, so how can I help you today?""",24.43,65.37
083_003,083,3,4,A month away now. So I've just got so much happening. Work is really demanding. Just failed this exam. I don't know what to do. All too much.,"Therapist: ""Okay, Masha, so how can I help you today?""
Patient: ""Well, I'm working full-time. I'm a part-time student. I've just gotten engaged and I live at home. There's just so much stress in my life. I have everything happening all at once. Just to top it all off, I failed an exam, a really big exam, and I just feel like I can't do anything anymore. I can't do anything right. I've just got so much stress and I feel like such a disappointment, such a failure. I've embarrassed my family by failing. I just don't know what to do anymore. I guess I've come here today to tell you I want to leave uni. I guess that's why I've come here to you today.""
Therapist: ""okay so it sounds like a whole lot of stuff's on top of you at the moment yeah just so much just all piling on yeah so you're working full-time plus time study um part-time study and then you've got your wedding preparation yeah just got engaged and weddings just""",83.64,95.2
083_005,083,5,4,"It's just been building up and building up and so much pressure with everything. I'm living at home so my parents, a lot of pressure. need to do everything right and by failing this I feel like I've just embarrassed them and disappointed them and I just don't feel like I'm good enough to go on studying.","Therapist: ""okay so it sounds like a whole lot of stuff's on top of you at the moment yeah just so much just all piling on yeah so you're working full-time plus time study um part-time study and then you've got your wedding preparation yeah just got engaged and weddings just""
Patient: ""A month away now. So I've just got so much happening. Work is really demanding. Just failed this exam. I don't know what to do. All too much.""
Therapist: ""So I imagine you've been sweating on this for a while and it's all been swirling around in your head.""",101.07,120.61
083_007,083,7,2,They haven't said much. I was really scared to tell them actually because I knew they'd just be so disappointed and just embarrassed by the fact that I did fail. I've never failed anything before and so it's really hard.,"Therapist: ""So I imagine you've been sweating on this for a while and it's all been swirling around in your head.""
Patient: ""It's just been building up and building up and so much pressure with everything. I'm living at home so my parents, a lot of pressure. need to do everything right and by failing this I feel like I've just embarrassed them and disappointed them and I just don't feel like I'm good enough to go on studying.""
Therapist: ""Okay, and have they said much to you about failing your exams?""",125.59,141.59
083_009,083,9,4,"Not at all, no. I think leaving uni will just be the way out just so I don't have to go through it again.","Therapist: ""Okay, and have they said much to you about failing your exams?""
Patient: ""They haven't said much. I was really scared to tell them actually because I knew they'd just be so disappointed and just embarrassed by the fact that I did fail. I've never failed anything before and so it's really hard.""
Therapist: ""So it's new and you don't like it at all?""",145.64,155.33
083_011,083,11,3,"um i think number two okay um read that one out for me that it's necessary to have a high degree of order and certainty in order to be happy and perform well yeah yeah you mentioned that earlier um number four that it's necessary to be competent and successful in all those things which are attempted yeah that's an expectation from your family yeah um Possibly number eight, that life should be entirely pleasant and enjoyable and that any frustration, discomfort or pain would be unbearable.","Therapist: ""So it's new and you don't like it at all?""
Patient: ""Not at all, no. I think leaving uni will just be the way out just so I don't have to go through it again.""
Therapist: ""Well I'm glad you've come to counselling because it's good for us to get an outsider's opinion when we've got so much on our plate and we're confused as to what to do and our emotions can get in the way and you've just said earlier that a whole lot of stuff is on your plate at the moment. So I'm glad you've come here. Here at the clinic we use the ABC model which is a cognitive behavioural therapy model. So Marsha, some counsellors have put together a list of beliefs that we often use and we don't realise that we're using those beliefs and they tend to be faulty ones. Here's the list here. Have a look through that to see if there are any beliefs that you might be operating on at the moment.""",207.43,243.67
083_015,083,15,4,That I need to be successful all the time in everything that I do.,"Therapist: ""Which one of those stands out the most for you at the moment?""
Patient: ""Probably number four.""
Therapist: ""How would you put that in your own words?""",257.59,262.55
083_017,083,17,2,"Well, failing that exam, I mean, I wasn't successful with that. It just throws out, I guess even number two, because it throws out all the order in my life. I need to have everything, you know, so I need to know what I'm doing, where I'm going.","Therapist: ""How would you put that in your own words?""
Patient: ""That I need to be successful all the time in everything that I do.""
Therapist: ""And is that different from what's happening in your life at the moment?""",267.83,284.06
083_023,083,23,2,"I mean, there are a lot of things, but I think Obviously failing the exam was the main one.","Therapist: ""Okay. All right. Well, what I'd like to do is put some of those ideas on the board under the ABC and I'll explain as we go along.""
Patient: ""Okay.""
Therapist: ""Okay. So what do you think the trigger point might be or the activating event for you at the moment?""",314.92,319.38
083_033,083,33,3,"I'm working it. It's a really demanding job and I'm keeping up with it, so I guess work. Things with my fiancé, I mean we're engaged so planning the wedding, that's going really well. It's stressful but it's going well.","Patient: ""That I'm not good enough.""
Therapist: ""Yeah, good.""
Therapist: ""It's really important for us to consider that kind of thinking. Okay, Marsha, it's good that we've got those things on the board. And what I'd like to do now is focus stepping out a bit from your situation and looking at it from another point of view. Okay. To me, it sounds like you're doing a whole lot of things really well. Can you list all of the things that you're doing really well?""",452.67,471.51
083_035,083,35,1,"Yeah, I've never failed anything before. This is the first one, so I guess all the other subjects, yeah.","Therapist: ""It's really important for us to consider that kind of thinking. Okay, Marsha, it's good that we've got those things on the board. And what I'd like to do now is focus stepping out a bit from your situation and looking at it from another point of view. Okay. To me, it sounds like you're doing a whole lot of things really well. Can you list all of the things that you're doing really well?""
Patient: ""I'm working it. It's a really demanding job and I'm keeping up with it, so I guess work. Things with my fiancé, I mean we're engaged so planning the wedding, that's going really well. It's stressful but it's going well.""
Therapist: ""And all of your other university subjects?""",477.16,483.59
083_037,083,37,2,"Yeah, this one just threw me off balance, yeah, just failing, yeah.","Therapist: ""And all of your other university subjects?""
Patient: ""Yeah, I've never failed anything before. This is the first one, so I guess all the other subjects, yeah.""
Therapist: ""And you're succeeding in all of those things put together. Yeah. You're juggling it and it's a lot on your plate at the moment, but it sounds like you've been able to cope up until this point of the one exam.""",499.63,504.64
083_045,083,45,1,"Just passing my subjects, not just exams. Yeah, that's right. Getting that full-time job. It's a great job that I'm doing. Getting married.","Therapist: ""And what's the evidence for that?""
Patient: ""Passing all my exams all the time.""
Therapist: ""Yeah.""",518.92,528.97
083_047,083,47,2,"I guess in comparison, I am good enough.","Therapist: ""Yeah.""
Patient: ""Just passing my subjects, not just exams. Yeah, that's right. Getting that full-time job. It's a great job that I'm doing. Getting married.""
Therapist: ""Yeah, that's right. Yeah. So how do all of those successes compare to that belief that I've written on the board for you?""",541.98,545.93
083_058,083,58,2,Yeah. I feel like I should stay.,"Therapist: ""Good. Okay. So, you've made a bit of a decision there, haven't you?""
Patient: ""Yeah.""
Therapist: ""Okay. Tell me about it. Does it feel okay?""",643.54,646.16
083_060,083,60,2,"I can try again. I mean, everything doesn't have to be 100% all the time.","Therapist: ""Okay. Tell me about it. Does it feel okay?""
Patient: ""Yeah. I feel like I should stay.""
Therapist: ""Okay. Why is that?""",649.61,654.17
083_062,083,62,3,"Yeah. I mean, I could re-sit the exam.","Therapist: ""Okay. Why is that?""
Patient: ""I can try again. I mean, everything doesn't have to be 100% all the time.""
Therapist: ""Good, good.""",656.18,658.5
083_064,083,64,1,"Yeah, I'll stay. I mean, I am good enough, so I'm sure I can give it another go and see how I go from there. I can reset the exam and I'm sure I'll be fine.","Therapist: ""Good, good.""
Patient: ""Yeah. I mean, I could re-sit the exam.""
Therapist: ""Okay. Yeah, yeah. and we've talked about all your successes yeah so it's harder now to believe that top statement that i'm not good enough yeah i mean i am good enough compared to all the things that you helped me realize with all the successes that i've had that's right i am good enough yeah good okay and so this idea about staying at uni Tell me about that.""",687.48,697.67
084_000,084,0,4,"Hello Heidi, how are you doing today? I'm doing okay, how are you?",(Beginning of session — no prior context),14.04,16.62
084_002,084,2,4,"Yeah, my anxiety has been really high lately. I just feel like I can't, everything is kind of chaotic and I can't get anything in order and just it's overwhelming.","Patient: ""Hello Heidi, how are you doing today? I'm doing okay, how are you?""
Therapist: ""I'm doing well, thanks for asking. I know last time I spoke with you, you had some concerns about your level of anxiety.""",27.55,42.73
084_006,084,6,2,"The upcoming college semester, I'm taking some really tough classes, kind of more advanced in my degree, and I'm just really nervous about passing them, and I don't know if I can handle it.","Therapist: ""The anxiety is overwhelming?""
Patient: ""Yes.""
Therapist: ""Do you know what you're feeling anxious about, what you're thinking about?""",51.53,65.64
084_010,084,10,4,"Yeah, not sure if I can pass, and if I don't pass, then am I going to have to repeat the semester, and just kind of just on and on.","Therapist: ""All right, so some concerns around the difficulty and the process of taking these classes.""
Patient: ""Yeah.""
Therapist: ""is leading to some anxiety. And the thoughts would be you're not sure if you can handle it.""",79.89,88.4
084_014,084,14,1,"I would say so. Yeah. Generally speaking, yeah.","Therapist: ""So one worry kind of builds on top of another.""
Patient: ""Yeah, for sure.""
Therapist: ""Is that how that cycle works for you? Do you start worrying about something kind of at a low level and then it tends to ramp up?""",100.63,103.7
084_016,084,16,3,"I think that'd be really helpful. I think if I could catch it earlier, I'd be able to control it a bit better.","Therapist: ""Is that how that cycle works for you? Do you start worrying about something kind of at a low level and then it tends to ramp up?""
Patient: ""I would say so. Yeah. Generally speaking, yeah.""
Therapist: ""So maybe if there was, if there were techniques we could use to try to intercept that anxiety earlier, would that be helpful?""",113.73,120.3
084_018,084,18,2,"Does that make sense? Yeah, that sounds great because just sitting here thinking about it is making me anxious.","Therapist: ""So maybe if there was, if there were techniques we could use to try to intercept that anxiety earlier, would that be helpful?""
Patient: ""I think that'd be really helpful. I think if I could catch it earlier, I'd be able to control it a bit better.""
Therapist: ""All right. I want to work on, there's a few areas we can look at, but I want to work on kind of grounding. So when you feel that anxiety starting to kind of build up and maybe at that point you kind of know it's going to spiral a little or likely going to spiral a little and start building. This would be a series of exercises that could help you kind of become centered and grounded and I would hope alleviate or kind of cut off that anxiety process.""",158.79,164.99
084_022,084,22,4,"My head definitely hurts a little behind my eyes. A little bit of a headache? Yeah. My neck definitely hurts, almost like I slept around. It's really tight. My stomach definitely feels like it's in a knot, kind of nauseous. My heart's beating a little faster. I think I'm breathing a little heavier too. I feel kind of jittery almost, like I just want to move.","Therapist: ""All right, so even right here with me, as you think about the classes, you have a feeling of anxiety. So let's work with that. So first I'd like you to think about, I want to stay in here and now. So we're going to move our focus to like right here, right now, as you're sitting here with me. And you can feel that anxiety inside of you, right?""
Patient: ""Yes.""
Therapist: ""So we think about anxiety and We have feelings about anxiety. We have sensations about anxiety. I want to focus on the sensations, so what it feels like in your body to be anxious. And if it helps to kind of list these feelings off, kind of start high, like with your head, and then just kind of move down. And tell me what you're feeling in your body as you also feel that anxiety.""",222.89,261.65
084_024,084,24,4,"Yeah, fidgety. That's a good word for it. Like I can't relax. Kind of just tense from head to toe almost.","Therapist: ""So we think about anxiety and We have feelings about anxiety. We have sensations about anxiety. I want to focus on the sensations, so what it feels like in your body to be anxious. And if it helps to kind of list these feelings off, kind of start high, like with your head, and then just kind of move down. And tell me what you're feeling in your body as you also feel that anxiety.""
Patient: ""My head definitely hurts a little behind my eyes. A little bit of a headache? Yeah. My neck definitely hurts, almost like I slept around. It's really tight. My stomach definitely feels like it's in a knot, kind of nauseous. My heart's beating a little faster. I think I'm breathing a little heavier too. I feel kind of jittery almost, like I just want to move.""
Therapist: ""Like fidgety?""",264.04,274.63
084_026,084,26,2,"Yeah, I would say it generally starts with the neck feeling kind of tense, and then the headache, and then it just kind of... And your stomach. And then my stomach, and then my heart starts racing.","Therapist: ""Like fidgety?""
Patient: ""Yeah, fidgety. That's a good word for it. Like I can't relax. Kind of just tense from head to toe almost.""
Therapist: ""So your whole body's tense. Yeah. kind of be aware in this moment, these sensations, as you are, as you're explaining them to me. Is this what happens each time the anxiety starts to build?""",290.22,301.55
084_028,084,28,2,"I don't think so. I don't think I've taken, I mean, the neck probably I've been aware of just because it hurts, but I don't think I've been aware of them as much as I am right now.","Therapist: ""So your whole body's tense. Yeah. kind of be aware in this moment, these sensations, as you are, as you're explaining them to me. Is this what happens each time the anxiety starts to build?""
Patient: ""Yeah, I would say it generally starts with the neck feeling kind of tense, and then the headache, and then it just kind of... And your stomach. And then my stomach, and then my heart starts racing.""
Therapist: ""All right, so you're familiar with these feelings you've been describing. Oh, yeah. Have you ever been... this aware of them before?""",311.96,324.27
084_030,084,30,2,"The picture, the flowers, chairs, table, lamp, the leaves on the flowers, table,","Therapist: ""All right, so you're familiar with these feelings you've been describing. Oh, yeah. Have you ever been... this aware of them before?""
Patient: ""I don't think so. I don't think I've taken, I mean, the neck probably I've been aware of just because it hurts, but I don't think I've been aware of them as much as I am right now.""
Therapist: ""Alright, so staying in that kind of moment of awareness. Alright, let's try building on this exercise to keep you grounded. One thing that sometimes helps when the anxieties starting, like it is for you right now, like you're starting to feel it and you can list off what's going on, is, and this is an effort to stay centered, is looking around the room, like this room that we're in here, and taking an inventory of the items. It's going to help focus your mind on something different, but also you're recognizing the environment and effort to become or stay centered. become grounded. So take a look around this room and let me know what you see.""",376.96,396.84
084_032,084,32,1,"It really helped. I felt my heart rate slowing down just to get focused on something else, I guess.","Therapist: ""Alright, so staying in that kind of moment of awareness. Alright, let's try building on this exercise to keep you grounded. One thing that sometimes helps when the anxieties starting, like it is for you right now, like you're starting to feel it and you can list off what's going on, is, and this is an effort to stay centered, is looking around the room, like this room that we're in here, and taking an inventory of the items. It's going to help focus your mind on something different, but also you're recognizing the environment and effort to become or stay centered. become grounded. So take a look around this room and let me know what you see.""
Patient: ""The picture, the flowers, chairs, table, lamp, the leaves on the flowers, table,""
Therapist: ""Alright, so what did it feel like to name and recognize everything, to take an inventory of your environment?""",409.46,419.23
084_036,084,36,2,"Yeah, I think that would really help because get those racing thoughts of one thing after kind of one worry leading to another and I think doing something like this to kind of focus on the environment around me would really help to slow those racing thoughts.","Therapist: ""So it seems to have maybe slowed things down for you?""
Patient: ""Yeah, definitely.""
Therapist: ""so if one of the factors that contributes to the anxiety escalating is an inability to slow down maybe this exercise will help you stay centered focus on the environment and just reduce the speed at which the anxiety builds and maybe short-circuited.""",451.74,465.64
084_038,084,38,1,"I've taken classes similar to these in the past and I've done well in them. I've always been a good student. So there's no reason to think that I wouldn't do well in these classes. If I am struggling, I can always get a tutor or ask a professor for help. And there's resources out there for me. I'm not alone. There's other classmates that I can lean on as well. And, I mean, I think the biggest one would just be I've been successful thus far in my undergrad career, and there's no reason to think that that success would stop now.","Therapist: ""so if one of the factors that contributes to the anxiety escalating is an inability to slow down maybe this exercise will help you stay centered focus on the environment and just reduce the speed at which the anxiety builds and maybe short-circuited.""
Patient: ""Yeah, I think that would really help because get those racing thoughts of one thing after kind of one worry leading to another and I think doing something like this to kind of focus on the environment around me would really help to slow those racing thoughts.""
Therapist: ""Now you have racing thoughts and you mentioned you had thoughts of like that you would not be successful in the classes. Yeah. And in cognitive therapy We have this self-talk. We talked about this before. This is what you say to yourself to counter those automatic thoughts. So what could you say to yourself as you're looking around the room and counting?""",495.92,546.72
084_044,084,44,4,"Yeah, definitely. I get so distracted by the thoughts that are not going to do well that it's hard to focus on the homework and the reading that needs to be done before the class.","Therapist: ""Yeah. You can understand you have resources, you've been successful before. The most likely outcome is you'll be successful. Yeah. So those are good adaptive responses, self-talk. that you can apply. And as you're counting, as you're looking and taking inventory, try to also be aware. So that's kind of a cognitive process as you can apply to self-talk. But try to be aware of your body. And just like the things you mentioned to me that you felt, try to be aware as it hopefully changes, as your feelings become less uncomfortable as you take that inventory. Does that make sense?""
Patient: ""Yeah, that makes sense.""
Therapist: ""Maybe a focus on, you know, I need to slow down. Let me take a look around here. Let me try to get grounded. Be more aware of your breathing. You mentioned that breathing was one of the things you were aware of. So maybe that can all contribute, work together to slow things down and to focus more on the logical, the most logical outcome, which is you'll probably do okay in these classes. And the anxiety really is working against that.""",628.89,638.64
084_048,084,48,1,I think that'd be a great idea. I think that'd be really helpful.,"Therapist: ""So maybe this grounding exercise is something you apply before doing homework as well.""
Patient: ""Yeah.""
Therapist: ""Just try to slow things down. Be aware of your breathing. Be aware of what you feel in your body. Be aware of your environment. And when you can relax a bit, start working on your homework.""",658.26,660.39
085_003,085,3,4,"Um, I've just been feeling like kind of in a rut. I mean, I've been looking for a job and haven't really gotten anywhere and then the, um, I had a drink the other night and I just felt like that like me not having a job and then me going out and having that drink like I just it wasn't deserved and I just felt like such a loser because I should have that was the time that I should have been at work if I had a job and instead I was at the bar drinking so I had one drink and then it led to another because then I just felt worse and I figured I had one so all right so how how much did you drink in total I think I lost track after four or five.","Therapist: ""Hey Carly, how you doing today?""
Patient: ""I'm good, how are you?""
Therapist: ""I'm doing well, thanks for asking. What's been going on this last week?""",22.99,76.84
085_005,085,5,4,I did really well. It was I think like three weeks. Three weeks?,"Therapist: ""I'm doing well, thanks for asking. What's been going on this last week?""
Patient: ""Um, I've just been feeling like kind of in a rut. I mean, I've been looking for a job and haven't really gotten anywhere and then the, um, I had a drink the other night and I just felt like that like me not having a job and then me going out and having that drink like I just it wasn't deserved and I just felt like such a loser because I should have that was the time that I should have been at work if I had a job and instead I was at the bar drinking so I had one drink and then it led to another because then I just felt worse and I figured I had one so all right so how how much did you drink in total I think I lost track after four or five.""
Therapist: ""How long had it been since you had a drink before that?""",84.88,89.64
085_011,085,11,4,"I mean, now I just kind of, I don't know, I'm afraid to go back. Like, I'm afraid to go out with, like, some friends. They invite me out to dinner, but I know there's alcohol and...","Therapist: ""Felt like a loser. And you feel that kind of led to drinking some more. Mm-hmm. So you had a rough time with things.""
Patient: ""Yeah.""
Therapist: ""Yeah. And how about now?""",117.65,130.27
085_017,085,17,2,"Just like shameful. Like I did really, really well and then here I was and I just finished a drink and I knew I wanted another one.","Therapist: ""Yeah. All right, so there's a few things going on. We've talked in the past, right, about separating the behavior from the person, right? So behavior is what we do, not who we are. You remember those discussions? And correct me if I'm wrong, but it sounds like I'll use some different words than you used, but it sounds like when you had that first drink, you're kind of ashamed that you had a drink and you had it during the time when you would have been working.""
Patient: ""Yeah, that's pretty accurate.""
Therapist: ""That's pretty accurate. All right. So taking yourself kind of back to that moment, right, where you had that first drink, like you finished that first drink, what was your thought? at that moment?""",193.91,205.76
085_019,085,19,4,I guess just I was doing well and then I had the drink and I just felt like an awful person. So I figured what was the hurt in having more.,"Therapist: ""That's pretty accurate. All right. So taking yourself kind of back to that moment, right, where you had that first drink, like you finished that first drink, what was your thought? at that moment?""
Patient: ""Just like shameful. Like I did really, really well and then here I was and I just finished a drink and I knew I wanted another one.""
Therapist: ""Okay. So shameful is kind of like the feeling, but the thought is I did really, really well, right? So that's what you're thinking was I did really, really well. And what, Was that the end of the thought or was there more before you had that next drink?""",227.52,240.66
085_021,085,21,4,"Yeah, I would say as I was finishing and then finished.","Therapist: ""Okay. So shameful is kind of like the feeling, but the thought is I did really, really well, right? So that's what you're thinking was I did really, really well. And what, Was that the end of the thought or was there more before you had that next drink?""
Patient: ""I guess just I was doing well and then I had the drink and I just felt like an awful person. So I figured what was the hurt in having more.""
Therapist: ""So the sequence would have been you had the drink, you felt shameful. At the same time you're thinking that you were doing really well. And then just really, as you said before, you just felt like a loser. And then you decided might as well just have the second drink. So another thought might be that, like I might as well just have the second drink. Yeah. Yeah. So you can see how there's some thoughts and some feelings at work right as you finish that first drink. Was it fairly quick? Were those thoughts and feelings fairly, um, occur fairly quickly after the drink?""",286.77,290.35
085_023,085,23,4,"Yeah, I already messed up. I might as well keep going.","Therapist: ""So the sequence would have been you had the drink, you felt shameful. At the same time you're thinking that you were doing really well. And then just really, as you said before, you just felt like a loser. And then you decided might as well just have the second drink. So another thought might be that, like I might as well just have the second drink. Yeah. Yeah. So you can see how there's some thoughts and some feelings at work right as you finish that first drink. Was it fairly quick? Were those thoughts and feelings fairly, um, occur fairly quickly after the drink?""
Patient: ""Yeah, I would say as I was finishing and then finished.""
Therapist: ""So right away you regretted it? Mm-hmm. And in that regret, as you thought about it, thought might as well just, just continue drinking now because You kind of blew it.""",309.54,313.06
085_025,085,25,2,"I would think that they had a rough day or something must have happened where, I mean, it's just one drink.","Therapist: ""So right away you regretted it? Mm-hmm. And in that regret, as you thought about it, thought might as well just, just continue drinking now because You kind of blew it.""
Patient: ""Yeah, I already messed up. I might as well keep going.""
Therapist: ""Okay. And that's a common cycle to fall into. And you had three weeks where you hadn't had a drink prior to that. So let's look at this. Let's try to separate the behavior from the self a little bit. If you had a friend who was in the same predicament, right, who had a history of using alcohol and then had three weeks without any alcohol use and then their behavior was to have a drink, what would you think of them?""",346.6,354.27
085_027,085,27,2,It's just they made a mistake.,"Therapist: ""Okay. And that's a common cycle to fall into. And you had three weeks where you hadn't had a drink prior to that. So let's look at this. Let's try to separate the behavior from the self a little bit. If you had a friend who was in the same predicament, right, who had a history of using alcohol and then had three weeks without any alcohol use and then their behavior was to have a drink, what would you think of them?""
Patient: ""I would think that they had a rough day or something must have happened where, I mean, it's just one drink.""
Therapist: ""Okay. They had a rough day, one drink, and what would you think of their behavior? How would you categorize that behavior?""",364.36,367.84
085_029,085,29,2,Yeah. I think irresponsible would be...,"Therapist: ""Okay. They had a rough day, one drink, and what would you think of their behavior? How would you categorize that behavior?""
Patient: ""It's just they made a mistake.""
Therapist: ""Not ideal. Depending on their point of view, maybe a little irresponsible.""",375.52,377.92
085_037,085,37,4,It was my mistake. It makes me a worse person for doing it.,"Therapist: ""But their behavior was a bit irresponsible.""
Patient: ""Yeah.""
Therapist: ""You know, in terms of, like, their recovery plan, which would be to not drink. Right. But when you apply that same examination to your own situation. How do you characterize yourself after you had that first drink?""",406.59,413.66
085_039,085,39,4,"Shameful. I mean, irresponsible. Just bad overall.","Therapist: ""You know, in terms of, like, their recovery plan, which would be to not drink. Right. But when you apply that same examination to your own situation. How do you characterize yourself after you had that first drink?""
Patient: ""It was my mistake. It makes me a worse person for doing it.""
Therapist: ""So you see how you're being a little, well, quite a bit rougher on yourself. Like your evaluation of yourself is fairly harsh. You mentioned loser earlier and ashamed. Whereas you wouldn't necessarily evaluate something else that way. How would you evaluate your behavior? How would you judge your behavior of taking that first drink?""",442.02,451.82
085_041,085,41,2,I Think we could be separated But if it feels like we're like I am that behavior in that moment I,"Therapist: ""So you see how you're being a little, well, quite a bit rougher on yourself. Like your evaluation of yourself is fairly harsh. You mentioned loser earlier and ashamed. Whereas you wouldn't necessarily evaluate something else that way. How would you evaluate your behavior? How would you judge your behavior of taking that first drink?""
Patient: ""Shameful. I mean, irresponsible. Just bad overall.""
Therapist: ""So bad, irresponsible, shameful. Is there a way to separate Behavior in terms of in terms of your thinking to miss the way you evaluate it from yourself like are you in the behavior? Together a meshed or can you be separated?""",474.42,488.24
085_043,085,43,2,"Yeah. I mean, just because you have one drink doesn't make you a horrible person, I would think, right?","Therapist: ""So bad, irresponsible, shameful. Is there a way to separate Behavior in terms of in terms of your thinking to miss the way you evaluate it from yourself like are you in the behavior? Together a meshed or can you be separated?""
Patient: ""I Think we could be separated But if it feels like we're like I am that behavior in that moment I""
Therapist: ""It's very congruent for you. Yes. The shame matches the behavior. The behavior matches shame. Like it's, they're one at that moment. But really, logically, rationally, you're you, right? You have an identity and values and your behavior is something you do. But in the moment, it's hard for you to see that. Looking back on it now, are you able to see the distinction between what people do and what they are?""",523.96,532.63
085_049,085,49,4,"I don't know. I mean, difficult because I like being around those people. But I guess it would be, it's risky.","Therapist: ""Yeah. So with that mentality, you kind of set yourself up for drinking more. So I think this is important because we've seen this cycle like where you have weeks of sobriety and then you'll drink a bit and then have weeks of sobriety. And I'm wondering if part of the difficulty you're facing is you're not coping with the slips as just slips.""
Patient: ""Okay.""
Therapist: ""You're allowing them to be gateways into a lot more drinking than a slip. Does that make sense? That sounds pretty accurate. And you see how the shameful feelings kind of just interfere with the behavior that's really consistent with your goals, which would be to not continue drinking. Another piece of this too is the associating with friends who drink. You're putting yourself in a treacherous situation. And again, that's a behavior, right? That doesn't make you one way or the other. It's a behavior. How would you judge that behavior, going out with friends?""",635.62,648.85
085_061,085,61,2,"Kind of, yeah.","Therapist: ""So maybe as you're confronting similar situations in the course of the next week, you could be aware of behaviors that might put you at risk and try to separate your identity from that behavior. So just judge the behavior.""
Patient: ""Okay.""
Therapist: ""Right, and don't pass any judgment on yourself. Does that make sense?""",739.39,742.63
085_067,085,67,2,"Yeah, I think that would probably be beneficial.","Therapist: ""Where you're making decisions based on that emotion instead of a rational judgment of the behavior.""
Patient: ""Okay.""
Therapist: ""Would that help a little bit?""",780.73,783.69
086_005,086,5,3,"Yeah, I've been thinking about some of that and, you know, trying to kind of work through it a little bit. So I think I'm kind of ready to kind of work through it and talk about it a little bit now.","Therapist: ""You're okay?""
Patient: ""Yeah.""
Therapist: ""I know when we talked last time, you were having a rough time dealing with the passing of your sister, Sheila. Yes. And you were kind of at a point where we were talking about emotional consequences, but also some of the thinking that's going on. Have you been processing that?""",42.14,62.25
086_009,086,9,2,"Yeah, I think I'm ready to think about it more.","Therapist: ""Right, so feeling a little less emotional and feeling a little more thinking about it and Like on the rational side, like we talked about rational and irrational beliefs.""
Patient: ""Yes.""
Therapist: ""A little more focus there, or more ability to focus there today.""",81.93,85.18
086_011,086,11,3,"But I think I've kind of got through some of that, and I'm ready to kind of get through the... the way I'm thinking about some things.","Therapist: ""A little more focus there, or more ability to focus there today.""
Patient: ""Yeah, I think I'm ready to think about it more.""
Therapist: ""I know the emotional part was tough for you, and I'm sure it still is.""",91.26,101.17
086_013,086,13,4,"Well, I've been thinking about it, and, you know, I just feel like I don't... I don't have anybody that I can talk to. I mean, I just keep thinking about it. I don't have anybody to talk to. She was the only one I had to talk to.","Therapist: ""I know the emotional part was tough for you, and I'm sure it still is.""
Patient: ""But I think I've kind of got through some of that, and I'm ready to kind of get through the... the way I'm thinking about some things.""
Therapist: ""All right, ready to look at it through the thinking lens. Right. Right, so to speak. All right, so what are some of the thoughts or beliefs that you've been having that you think may be part of what's affecting your mood?""",118.81,140.83
086_015,086,15,4,"everything. And, you know, she was just always gave me good advice, and she could always work, you know, talk me through anything that I needed to talk about, and I just don't feel like I have that. And when she's, you know, since she's gone, I don't have anybody like that anymore.","Therapist: ""All right, ready to look at it through the thinking lens. Right. Right, so to speak. All right, so what are some of the thoughts or beliefs that you've been having that you think may be part of what's affecting your mood?""
Patient: ""Well, I've been thinking about it, and, you know, I just feel like I don't... I don't have anybody that I can talk to. I mean, I just keep thinking about it. I don't have anybody to talk to. She was the only one I had to talk to.""
Therapist: ""So, in your relationship with her, you guys talked a lot. She was an important person your life for a variety of reasons but including that she was easy to talk to yes and that you could talk to her yeah so the thought is you have nobody to talk to I just you know she was just everything to me I talked to her about""",168.46,188.48
086_019,086,19,2,"Well, you know, since you said that, you know, maybe I do have some people that I can go to. They're not her, but, you know, You know, I have a couple of people that I can talk to, that they're willing to talk to me about certain things. I guess if I give them the chance, you know, I'd be able to talk to them.","Therapist: ""That relationship was valuable to you, and you've lost that, and you feel like you've lost having anybody that you can talk to. Is that close?""
Patient: ""Yes. Yeah.""
Therapist: ""All right. So let's look at that thought. Let's break that down. Okay. Certainly, you were able to talk to her, as you mentioned, and you have lost her. Yes. So you have lost someone that you could talk to that was very valuable to you, and that's understandably painful. Yes. The question would be, have you lost everybody that you could talk to? Is there anyone else in your life, for instance, currently, that you regularly speak with?""",239.21,271.7
086_023,086,23,2,"Yeah, that sounds about right. Yeah? Yeah, yeah. Because nobody's going to replace my sister. But, you know, I do think that there's other people that could help me and what I need to talk.","Therapist: ""So there are some people in your life that you can talk to. They certainly don't replace your sister. But you have people you can communicate with, and that can be helpful for you.""
Patient: ""Yes.""
Therapist: ""So as we build kind of a rational self-talk to replace the irrational thinking that you brought in, right, which was that you have no one to talk to, could the replacement be something like, I had my sister to talk to and she was really good at that and it's painful that I've lost her, but I gained something from that experience and I do still have some people to talk to now?""",318.66,335.69
086_025,086,25,4,"Right. Yeah, because, you know, she is like the only one that believed in me. I mean, she just, you know, She always, you know, pushed me to go higher and, you know, on my job. She always said that, you know, that you can do it, you know, just believe in yourself. She always, you know, encouraged me to go back to school and, you know, I have done that and you know, continually doing that, you know. But, you know, she was a big motivator for me. And, you know, since she's gone now, you know, I don't feel like that I have anybody else that gives me that push that she did.","Therapist: ""So as we build kind of a rational self-talk to replace the irrational thinking that you brought in, right, which was that you have no one to talk to, could the replacement be something like, I had my sister to talk to and she was really good at that and it's painful that I've lost her, but I gained something from that experience and I do still have some people to talk to now?""
Patient: ""Yeah, that sounds about right. Yeah? Yeah, yeah. Because nobody's going to replace my sister. But, you know, I do think that there's other people that could help me and what I need to talk.""
Therapist: ""Yeah, and maybe one thing that you can take away from this as well is that because of the way you could talk to your sister, you are more effective communicator now. And you can make the most out of the relationships that you have now with people currently. And another rational thought kind of honors her contribution to you.""",361.07,420.52
086_029,086,29,4,"Well, I do have very encouraging parents. They've always been somewhat of encouragement, but they just didn't have that extra push that she did. But they're encouraging. And I have encouraging friends. Some of my friends want to see me succeed. And they give me encouraging words and tell me to keep going. She stopped at nothing to make me go. She just didn't take no for an answer. If she had to go with me to do something, she would. That's why I just felt like I wasn't going to make it without her pushing me.","Therapist: ""So the thought would be, I've lost the only person that would believe in me? Yes. Something like that? Okay. So she was a great positive force, a great positive presence and contributor in your life, in part because she believed in you. Yes. And now that's gone and you feel like no one else will believe in you in that way. Not like she did. Not like she did.""
Patient: ""No, no.""
Therapist: ""Which could be true, right? There may be no one else that ever believes in you that same way. But similarly, like we were doing before, can you think of some people now that believe in you maybe in a different way that's still helpful? It doesn't replace her, but it might still be helpful to you.""",471.98,531.03
086_031,086,31,3,"Well, yes, because she's been going and I've continued to go to school. And every time I feel like I wanna give up, I keep on saying, I got to keep going, you know, my sister would want me to keep going, you know, and she would want me to succeed and I have to, you know, keep my focus because she always talked about me, you know, keeping my focus. So, you know, those things that she taught me and instilled in me, I still hold on to. And it's, you know, it's kept me going. so she contributes to your life even now well yes yes because of what she does yeah because i still kind of hear her words of what she says to me you know what she said to me all the time and i hold on to that and that's what you know drives me and i think that's a fairly useful","Therapist: ""Which could be true, right? There may be no one else that ever believes in you that same way. But similarly, like we were doing before, can you think of some people now that believe in you maybe in a different way that's still helpful? It doesn't replace her, but it might still be helpful to you.""
Patient: ""Well, I do have very encouraging parents. They've always been somewhat of encouragement, but they just didn't have that extra push that she did. But they're encouraging. And I have encouraging friends. Some of my friends want to see me succeed. And they give me encouraging words and tell me to keep going. She stopped at nothing to make me go. She just didn't take no for an answer. If she had to go with me to do something, she would. That's why I just felt like I wasn't going to make it without her pushing me.""
Therapist: ""Her level of belief in you was higher or different or better than what you have now in some ways yes like she was really committed to her belief in you it sounds like yes so some people currently do believe in you and that's good it doesn't replace her level of belief her type of belief in you yes I also wonder if by her believing in you you mentioned that it helped you with all kinds of accomplishments. So I wonder if that's not a thought that you can use here as an adaptive response. That because she believed in me, I was able to do all these things. And maybe, because she believed in you so much, she taught you how to believe in yourself to some extent.""",587.79,654.55
086_033,086,33,3,"That's what I, that's the only way I keep going is, is I hold on to that.","Therapist: ""Her level of belief in you was higher or different or better than what you have now in some ways yes like she was really committed to her belief in you it sounds like yes so some people currently do believe in you and that's good it doesn't replace her level of belief her type of belief in you yes I also wonder if by her believing in you you mentioned that it helped you with all kinds of accomplishments. So I wonder if that's not a thought that you can use here as an adaptive response. That because she believed in me, I was able to do all these things. And maybe, because she believed in you so much, she taught you how to believe in yourself to some extent.""
Patient: ""Well, yes, because she's been going and I've continued to go to school. And every time I feel like I wanna give up, I keep on saying, I got to keep going, you know, my sister would want me to keep going, you know, and she would want me to succeed and I have to, you know, keep my focus because she always talked about me, you know, keeping my focus. So, you know, those things that she taught me and instilled in me, I still hold on to. And it's, you know, it's kept me going. so she contributes to your life even now well yes yes because of what she does yeah because i still kind of hear her words of what she says to me you know what she said to me all the time and i hold on to that and that's what you know drives me and i think that's a fairly useful""
Therapist: ""way of looking at things, right? Do you find that to be useful? I find it to be very useful. Very useful.""",660.02,665.22
086_037,086,37,2,"Yeah, I think there's something that I can do. Yeah? Yeah. So if I try, I believe that I can. Those are some good things to work with.","Therapist: ""Right, so you're getting, you're getting something positive from that relationship, right?""
Patient: ""Yes.""
Therapist: ""Yeah. So there's a couple things we talked about here then. We had the, we had a couple different kind of irrational or less than useful beliefs. And then a couple adaptive responses, actually quite a few adaptive responses that you can apply. Still realistic, but more positive and more useful for you. Do you feel like you can follow through with these adaptive responses and try out this thinking, this new behavior during this week?""",707.86,720.34
086_039,086,39,3,"Well, I think it's put me in a better place emotionally because, you know, since, you know, looking at those things more differently kind of helped me. to get in a better place emotionally. Of course I'm sad, I'm still sad over it, but those things help me get through it and make me look on the brighter side of things. So I think that kind of really helps me a lot.","Therapist: ""Yeah. So there's a couple things we talked about here then. We had the, we had a couple different kind of irrational or less than useful beliefs. And then a couple adaptive responses, actually quite a few adaptive responses that you can apply. Still realistic, but more positive and more useful for you. Do you feel like you can follow through with these adaptive responses and try out this thinking, this new behavior during this week?""
Patient: ""Yeah, I think there's something that I can do. Yeah? Yeah. So if I try, I believe that I can. Those are some good things to work with.""
Therapist: ""How are you doing emotionally now after kind of processing these thoughts and considering the adaptive responses, the rational beliefs?""",731.55,765.19
087_003,087,3,1,"Since last session, it seems to be in check. Nothing really major has been going on with it, so I think I'm getting to a point where it's under control.","Therapist: ""Alisa, how are you doing today?""
Patient: ""Good, how are you?""
Therapist: ""I'm doing well, thanks for asking. How has the anxiety been going?""",24.53,36.28
087_007,087,7,4,"So work's a little bit of a different story. We have our daily meetings and I actually had to pull one of my co-workers aside because I feel like they undermine me all the time. And they don't give me the respect, basically, that I deserve. So I took her outside after the meeting and laid into her about it. And afterwards, I mean, the next day, because we have these meetings every day, she, like, she came back and came at me again, but it was worse, even after talking to her.","Therapist: ""It's subsided a bit? Mm-hmm. That's good.""
Patient: ""Yeah. That's good.""
Therapist: ""How have things been going at work lately?""",44.26,97.85
087_009,087,9,2,"Well, I just feel that I do a good job and I deserve to be respected by my coworkers.","Therapist: ""How have things been going at work lately?""
Patient: ""So work's a little bit of a different story. We have our daily meetings and I actually had to pull one of my co-workers aside because I feel like they undermine me all the time. And they don't give me the respect, basically, that I deserve. So I took her outside after the meeting and laid into her about it. And afterwards, I mean, the next day, because we have these meetings every day, she, like, she came back and came at me again, but it was worse, even after talking to her.""
Therapist: ""So talking to her. That didn't improve your situation. No. So you have these, someone understands, you have these daily meetings, right? And you mentioned that she's not showing you respect and that you deserve respect, right? Something to that effect. So tell me about that belief. Remember we talked about kind of ABC before activating events and beliefs and consequences in RABT. Tell me about that belief.""",131.56,145.77
087_011,087,11,3,"I don't know if there's a certain level, but I feel just like I deserve it. You know?","Therapist: ""So talking to her. That didn't improve your situation. No. So you have these, someone understands, you have these daily meetings, right? And you mentioned that she's not showing you respect and that you deserve respect, right? Something to that effect. So tell me about that belief. Remember we talked about kind of ABC before activating events and beliefs and consequences in RABT. Tell me about that belief.""
Patient: ""Well, I just feel that I do a good job and I deserve to be respected by my coworkers.""
Therapist: ""Yeah, it just... Are there levels of respect? Is there a certain level of respect that you demand or need?""",162.71,168.67
087_013,087,13,4,"Well, she was like shooting down my ideas and just kind of made me feel like a fool, basically. So I just, I didn't understand.","Therapist: ""Yeah, it just... Are there levels of respect? Is there a certain level of respect that you demand or need?""
Patient: ""I don't know if there's a certain level, but I feel just like I deserve it. You know?""
Therapist: ""And what did she do that kind of convinced you that she wasn't meeting that level of respect?""",178.42,191.94
087_019,087,19,2,"I mean, now that you point it out, I mean, I guess I can view it in that way, that it wasn't.","Therapist: ""Have you criticized other co-workers?""
Patient: ""Yeah.""
Therapist: ""So do you think that her criticism was within normal limits, like within what you've kind of seen there regularly?""",241.2,249.69
087_021,087,21,2,"It just felt like she was purposely trying to nitpick, if you will.","Therapist: ""So do you think that her criticism was within normal limits, like within what you've kind of seen there regularly?""
Patient: ""I mean, now that you point it out, I mean, I guess I can view it in that way, that it wasn't.""
Therapist: ""It wasn't too far out of line the first time, right? But then after you talked to her, you said that it got worse. Yeah.""",260.61,266.26
087_023,087,23,2,"I mean, I guess I may have gone at her a little harshly. But I felt at the time that it was reasonable.","Therapist: ""It wasn't too far out of line the first time, right? But then after you talked to her, you said that it got worse. Yeah.""
Patient: ""It just felt like she was purposely trying to nitpick, if you will.""
Therapist: ""Trying to get at you a little bit. Yeah. So maybe the second time around, correct me if I'm wrong, maybe she was actively showing you disrespect just because of what you had done because you came after her and Or was that with the normal limits too? I don't know.""",290.35,304.77
087_027,087,27,2,"Well, um, I've just been trying not to talk to her. Um, and obviously in a work situation, it doesn't really help.","Therapist: ""At the time when you were...""
Patient: ""When I was talking to her outside of the meeting.""
Therapist: ""Alright, so you felt that she was a bit harsh. You talked to her about it, but then she's become more harsh. So where do you stand with her now? Like, with the meetings and such?""",323.38,335.13
087_029,087,29,2,So I guess the confrontation I had with her?,"Therapist: ""Alright, so you felt that she was a bit harsh. You talked to her about it, but then she's become more harsh. So where do you stand with her now? Like, with the meetings and such?""
Patient: ""Well, um, I've just been trying not to talk to her. Um, and obviously in a work situation, it doesn't really help.""
Therapist: ""That's not convenient. Yeah. It might not help. Alright. So... Let's work this through using the ABC model that we used for the anxiety that you had before, that was troublesome to you before. What would the activating event be here in this situation?""",358.77,365.42
087_033,087,33,2,"So she criticized me, and I felt disrespected.","Therapist: ""Well, you could look at that as an activating event. Another way to look at it is her criticism of you could have been the activating event. And your conversation with her could have been the consequence. But these things are cyclical. So it's sometimes hard to know where to cut in and put the A and the B and the C. Let's just work it through with the activating event being what she said. Let's just try that and see how that works out. Would that be reasonable? That could have been kind of what started it, was this criticism.""
Patient: ""Yeah, yeah.""
Therapist: ""All right, so then what would the belief... So all activating events, right, are filtered through our belief system. So what would your beliefs be in that scenario?""",419.63,424.52
087_035,087,35,3,And I feel her... My belief is that I deserve respect.,"Therapist: ""All right, so then what would the belief... So all activating events, right, are filtered through our belief system. So what would your beliefs be in that scenario?""
Patient: ""So she criticized me, and I felt disrespected.""
Therapist: ""That's a feeling.""",426.92,432.64
087_037,087,37,4,So that being upset and disrespected Aggravation.,"Therapist: ""That's a feeling.""
Patient: ""And I feel her... My belief is that I deserve respect.""
Therapist: ""Right, and that came first. So you have the activating event, which is hurt criticism, processed through your belief, which is that you must have respect, you deserve respect. You mentioned the feeling. So tell me about the feelings.""",452.88,462.92
087_041,087,41,4,Frustration.,"Therapist: ""It was aggravation.""
Patient: ""Yes.""
Therapist: ""Frustration.""",465.06,467.13
087_043,087,43,2,"Well, if we, like, go forward, it's the... the kind of disarray or the tension, I guess, now in the office.","Therapist: ""Frustration.""
Patient: ""Frustration.""
Therapist: ""So that would be one of the consequences of how you processed her behavior. Does that make sense? The feeling, the frustration feeling, would be one of the consequences, like an ABC. Gotcha. So you have the activating event. She criticizes you. Your belief is that you deserve respect. and that clearly she violated that belief, right? She didn't show you the respect that you deserved, according to your belief system. And then one of the consequences, therefore, was this feeling of frustration. Were there any other consequences?""",505.56,518.87
087_047,087,47,1,"It does. Yeah, and I mean, when you put it that way and then you say it's cyclical, then you just, I can visualize it. going around like a carousel.","Therapist: ""So you got, that's definitely a consequence. I'm thinking there's an intermediate consequence, though. So you had that feeling of frustration, and what's the next thing you did after that meeting was over?""
Patient: ""Oh, well, I confronted her.""
Therapist: ""You confronted her, right. So you have kind of those two consequences. And that confrontation, it would appear, has led her to kind of come on more strongly with her criticisms. which is another activating event. You could also think of it as a consequence, but like I said, this is a cyclical. So you see how the A and the B and the C, that paradigm can fit in to what happened here at work for you. Does that make some sense?""",564.08,576.98
087_049,087,49,2,"Tell me about that. I mean, I understand what you're saying. I get it. I guess it's just kind of like the anxiety. With the anxiety we worked on, it's just getting there.","Therapist: ""You confronted her, right. So you have kind of those two consequences. And that confrontation, it would appear, has led her to kind of come on more strongly with her criticisms. which is another activating event. You could also think of it as a consequence, but like I said, this is a cyclical. So you see how the A and the B and the C, that paradigm can fit in to what happened here at work for you. Does that make some sense?""
Patient: ""It does. Yeah, and I mean, when you put it that way and then you say it's cyclical, then you just, I can visualize it. going around like a carousel.""
Therapist: ""Sure, exactly. So it helps you to kind of see what caused what and maybe what could have been changed or could be changed in the future, right? Because we can't go back and change that, but we can work on the future. So her criticism of you, there's no direct way to change that. The consequence is a consequence. So that leaves the belief system, right? Which is the deserving, respect. One of the things we try to do in REBT is help people move from rigid thinking to more flexible thinking. So, kind of a rigid belief system would be, and not that you said it in this way, but, you know, I demand and deserve respect, right, at this particular level, and people aren't meeting it. Would you say that's a fair? Yeah. Maybe a more flexible way of thinking would be that you'd like respect, right? Respect's good. Respect's healthy in work environments, certainly. But if you don't get it, you can still function. And that's tough for you. I can see that's tough.""",655.48,669.56
087_055,087,55,4,"Yeah, it starts in my stomach and then goes all the way up.","Therapist: ""Yeah. It's tough, though. Just, as you mentioned, like, with the anxiety, this is tough. How long have you had this belief, kind of this mentality of... I deserve respect. Oh gosh.""
Patient: ""Since I was like a teenager.""
Therapist: ""So a long time. So this has been a relatively persistent part of your life, this belief system. So changing it's going to be work. Yeah. So if you can apply a different philosophy, apply more flexible thinking the next time you're in a meeting, She's still criticizing you in the meetings? Yeah. So if you filtered that through a belief system, now your first urge might be, I would think, to be, I'm being disrespected again, right? It probably comes on that way. You kind of feel it.""",736.23,739.77
087_057,087,57,1,"Yeah. For my friends and my family, I feel like they give me, it's actually mutual respect. They give me respect, I give them respect.","Therapist: ""So a long time. So this has been a relatively persistent part of your life, this belief system. So changing it's going to be work. Yeah. So if you can apply a different philosophy, apply more flexible thinking the next time you're in a meeting, She's still criticizing you in the meetings? Yeah. So if you filtered that through a belief system, now your first urge might be, I would think, to be, I'm being disrespected again, right? It probably comes on that way. You kind of feel it.""
Patient: ""Yeah, it starts in my stomach and then goes all the way up.""
Therapist: ""So that would be your first physiological reaction, right, an emotional reaction. But if you can kind of pause that moment and apply more flexible thinking, like I talked about, which is I like respect, but I can survive and function without it. At some level, I can accept that I'm not going to get it all the time. Are there other areas of life where you do get respect?""",772.03,784.82
087_061,087,61,1,"Well, I think over time, if I learn to do that first, starting like with inside of me, like I wouldn't get that. initial, like, punch to the gut, um, and I wouldn't have the urge to lash out at her, um, especially if it is trying to be constructive criticism, um, resulting in a situation where there's not tension in our office.","Therapist: ""So that need, if that's a need, that's being met, right? Maybe not by this one coworker, right? So maybe she's being disrespectful. Or, as we talked about before, maybe that's the way you're interpreting it and she never really intended to be disrespectful because criticism is part of what happens in those meetings.""
Patient: ""True.""
Therapist: ""So you don't, you know, I don't really know which is which and you may not either at this point. So what do you think would happen if you could take that criticism the next time it occurs and run it through that more flexible belief system? What would be the consequences?""",828.15,864.48
087_063,087,63,1,"I think I'd be able to do that. I think I'd be able to approach her and maybe ask her if she'd want to get coffee or something and maybe sit down and kind of talk it over with her. Maybe I misunderstood her in the first meeting and she really didn't mean to undermine me, as I said, and then go from there.","Therapist: ""So you don't, you know, I don't really know which is which and you may not either at this point. So what do you think would happen if you could take that criticism the next time it occurs and run it through that more flexible belief system? What would be the consequences?""
Patient: ""Well, I think over time, if I learn to do that first, starting like with inside of me, like I wouldn't get that. initial, like, punch to the gut, um, and I wouldn't have the urge to lash out at her, um, especially if it is trying to be constructive criticism, um, resulting in a situation where there's not tension in our office.""
Therapist: ""Alright, so you So if you could filter it through that belief system, and it would help if it was constructive, that would help you filter it through that, to be at that belief system. Functioning in the office would improve for you. Stress would be reduced for you. Ultimately. Is there a way to kind of patch things up with this co-worker to maybe explain that you understand a little more about her criticisms and maybe just try to smooth things over?""",907.29,937.15
087_065,087,65,2,"Yeah. Because I certainly don't want, like, our upper management to, you know, get involved and there be a bigger issue.","Therapist: ""Alright, so you So if you could filter it through that belief system, and it would help if it was constructive, that would help you filter it through that, to be at that belief system. Functioning in the office would improve for you. Stress would be reduced for you. Ultimately. Is there a way to kind of patch things up with this co-worker to maybe explain that you understand a little more about her criticisms and maybe just try to smooth things over?""
Patient: ""I think I'd be able to do that. I think I'd be able to approach her and maybe ask her if she'd want to get coffee or something and maybe sit down and kind of talk it over with her. Maybe I misunderstood her in the first meeting and she really didn't mean to undermine me, as I said, and then go from there.""
Therapist: ""So either way, gathering the information, meaning having a discussion with her, would be helpful because, I mean, you may find that you really see things alike and it was just a disagreement in terms of her criticism and the way you interpret it. Or she may have been trying to be critical and you'll know that too. Yeah. Right? You really can't control someone else's behavior. But it would give you an idea of maybe what our intentions were and how you can go forward to repair that relationship so that it functions.""",971.0,981.99
087_069,087,69,1,"Yeah, it's pretty clear. You explained it really well. Thank you.","Therapist: ""You don't want them to have to come and sort that out. Right. You can sort out your own. Yeah. Right. And that would be a good application of coping skills and flexible thinking. So is that something you feel like you can try over the course of the next week?""
Patient: ""I will definitely try.""
Therapist: ""So really our plan moving forward has a couple parts. So one would be spoon things over in a sense, discussing this with her, letting her know you're aware of what's going on and you want to try to resolve it. And the second part would be trying to move a little bit away from the rigid, you know, I deserve respect to I would like respect but I'll function adequately without respect from everyone. I know that's tough. That's going to be the challenge. But this will give us good information and give you some practice. Does it all make sense to you?""",1052.69,1057.8
088_003,088,3,1,"Better. Well, last time we talked about that... Postponegraphication? Yeah, that. And I think you wanted 10 minutes for me to open it up.","Therapist: ""Hi, Carly. How are you doing today?""
Patient: ""I'm good.""
Therapist: ""How about you? I'm doing well. Thanks for asking. How did you do this week?""",22.8,35.62
088_005,088,5,1,"So, I did better. I think I ended up only doing like a joint and a half instead of two. I was able to put it off for, I think, the 10 minutes a couple of times. And then, um, there were, there was I think one or two days where I went out for a walk cause I was tired of staring at the clock waiting for the 10 minutes to pass. So I got up, went for a walk and then I passed one of my friends. So I ended up walking with her and I actually didn't get back to my house for like an hour. So I kind of put it off for like an hour because then I came home and took a couple hits.","Therapist: ""How about you? I'm doing well. Thanks for asking. How did you do this week?""
Patient: ""Better. Well, last time we talked about that... Postponegraphication? Yeah, that. And I think you wanted 10 minutes for me to open it up.""
Therapist: ""10 minutes, yeah.""",36.42,81.02
088_009,088,9,1,"Yeah. I found, I actually like talked to a couple of people on the phone and before I knew it, like half hour had gone by.","Therapist: ""All right. So it sounds like you were able to maintain waiting 10 minutes to smoke marijuana, at least. It was rough. It was rough? It was rough. So it was difficult for you, but in most cases you were able to hold off the 10 minutes. And it sounds like there was a few instances where you were able to hold it off longer because something else kind of,""
Patient: ""Yeah.""
Therapist: ""Came up.""",106.75,112.52
088_013,088,13,1,Yeah. I guess I just wasn't thinking about it.,"Therapist: ""So another, so another activity presented itself and you forgot about the marijuana?""
Patient: ""Kind of.""
Therapist: ""Yeah.""",125.51,129.12
088_017,088,17,1,"I mean, I don't see it as a problem. It's legal in a lot of states now, and I mean, it's not that bad for you. It doesn't really endanger me much.","Therapist: ""So has your, um, Have your feelings about marijuana changed since we last talked?""
Patient: ""No, not really.""
Therapist: ""Tell me about that.""",139.19,155.47
088_019,088,19,2,"Yeah, I mean, I'm not hurting anybody else.","Therapist: ""Tell me about that.""
Patient: ""I mean, I don't see it as a problem. It's legal in a lot of states now, and I mean, it's not that bad for you. It doesn't really endanger me much.""
Therapist: ""So you still believe you should have the right to...""",162.16,164.96
088_023,088,23,1,"Yeah, I think two to three months.","Therapist: ""But at the same time, you want to go back to work. And if I remember right, you're the person that you could go work for. I guess you know them, right?""
Patient: ""Yeah, it's my uncle.""
Therapist: ""Your uncle. And you need to be clean for, what is it, about two months?""",185.49,189.29
088_025,088,25,4,"Yeah. I mean, my parents are pretty cool with it. Like they know, but I mean, I'm at the point now where they kind of want me to move on and move out, but I don't know. I mean, I just, it'd be nice to have that job. Like, it's a really good job, but at the same time, like, I don't see why I have to sacrifice something that I like.","Therapist: ""Your uncle. And you need to be clean for, what is it, about two months?""
Patient: ""Yeah, I think two to three months.""
Therapist: ""you have kind of opposing forces here, right? You have your enjoyment of marijuana and then you, you know, that's something you like, you don't want to give up and you believe you should have a right to do that. But then there's that job.""",204.49,229.17
088_029,088,29,2,"Yeah, it's pretty accurate. Okay.","Therapist: ""So it doesn't seem fair to you, but you recognize it's the reality of your situation.""
Patient: ""Yeah.""
Therapist: ""So it really does come down, in your instance, to marijuana use or employment.""",241.62,244.51
088_037,088,37,2,"I think I did like 15, 15 and 20.","Therapist: ""It was difficult for you. So I asked you to track the number of times you smoked marijuana. Did you, were you able to track that over the last week?""
Patient: ""Yeah, for the most part.""
Therapist: ""Do you remember how many times that was?""",280.02,289.49
088_039,088,39,2,"Almost closer to 20 times, I guess. Otherwise, I probably would have kept going, smoked more. I mean, there were a couple times where, like, somebody would call me or somebody would text me, and that kind of distracted me. So I was able to put it off for a little bit.","Therapist: ""Do you remember how many times that was?""
Patient: ""I think I did like 15, 15 and 20.""
Therapist: ""Between 15 and 20. And how many times did something kind of get in the way? Did something else come up in that 10 minute span that distracted you or that you enjoyed?""",305.33,325.18
088_043,088,43,4,"I don't know. That seems kind of, that seems like a longer time.","Therapist: ""So you can see in that 10 minutes, things can happen. Mm-hmm. Right? Things can happen that can help you to avoid the marijuana. Sometimes nothing does, and after 10 minutes, you use it. And sometimes something does kind of get in the way with the marijuana, like distract you, or you have another activity that you enjoy, and then you didn't use. So with that in mind, you found the experience rough, but was it tolerable?""
Patient: ""Yeah, it wasn't bad.""
Therapist: ""It wasn't bad? Do you think for this next week, We could try postponing that gratification from 10 minutes to 20 minutes.""",372.19,375.96
088_045,088,45,2,"I don't know about that. Yeah. Um, maybe like 15 minutes.","Therapist: ""It wasn't bad? Do you think for this next week, We could try postponing that gratification from 10 minutes to 20 minutes.""
Patient: ""I don't know. That seems kind of, that seems like a longer time.""
Therapist: ""That is definitely, that is a longer time.""",378.64,384.44
088_047,088,47,2,I think I could try a little bit more than 20.,"Therapist: ""That is definitely, that is a longer time.""
Patient: ""I don't know about that. Yeah. Um, maybe like 15 minutes.""
Therapist: ""You want to compromise at 15? Okay. Do you think you could, uh, maintain 15 minutes? Waiting 15?""",391.63,393.69
088_053,088,53,4,"Yeah. It doesn't make it any easier, but...","Therapist: ""Watch TV? Okay. Well, so perhaps in that 15-minute time period, that time you're delaying, marijuana, you could start watching the show that you like?""
Patient: ""Yeah, I could do that.""
Therapist: ""At the end of 15 minutes, you might end up using the marijuana or you might want to continue watching the show. So do you see kind of how it works? Is it making sense to you, the postponing?""",471.22,474.16
088_055,088,55,2,"Yeah. No, I definitely see how it helps.","Therapist: ""At the end of 15 minutes, you might end up using the marijuana or you might want to continue watching the show. So do you see kind of how it works? Is it making sense to you, the postponing?""
Patient: ""Yeah. It doesn't make it any easier, but...""
Therapist: ""It's tough for you, yeah.""",475.4,479.93
088_063,088,63,2,"Yeah, I think I can manage that.","Therapist: ""Good. And if you do the same thing, if you could kind of write down the number of times that you used, like, you know, mark each time you used and kind of what happened, you know, in terms of the 15-minute wait. Okay. Right. Actually, I guess more accurately, every time that you initiate a 15-minute wait period would be a good time to note it. Okay. Right, because the idea is that something's going to come up and that you're going to have an opportunity to distance yourself from the use and you won't use as much. So I want to kind of get an idea of the thought process that's occurring as you start that 15 minute, right? And if you end up using, what happened then? If you end up not using, kind of like the outcome for each. Okay. Possible scenario, right? And then we can kind of analyze that and we can see if moving the minutes up would be something we could do.""
Patient: ""Okay.""
Therapist: ""Does that sound like a plan?""",625.21,628.23
089_001,089,1,4,"Probably pretty high. Okay. Yeah, probably like an eight or nine.","Therapist: ""Okay, well welcome to our session today and I already see that you're feeling fairly anxious before we get started here and that's what today's session is about. It's about exposure and we're gonna just jump right into it. I want you to remember that you're going to experience me differently during our exposure than typical. So what I'll be doing is I'll just be simply asking you about what your SUDs are, your Subjective Units of Distress, on a scale of 1 to 10. And I'll be watching the clock. Every minute or two, we'll ask you about that. And we're just going to watch your anxiety go up, and we're going to just watch it come down. And then afterwards, we'll kind of do a debrief afterwards. But in the middle of it, I'll just be asking you about those sets, okay? Okay. All right. And because of your obsessions about germ phobias, today we decided you were going to just be holding the garbage can on your lap. Right? Yep. Okay. So without even kind of debriefing or anything about that too much, let's get started on that. Okay. And then afterwards we'll do some talking about what that was like for you. Okay. So here it comes. Okay. Okay. Just right off the bat, Kate, what are your subs at 1 to 10?""",84.19,90.82
089_005,089,5,2,Probably pretty close to a 10.,"Therapist: ""An eight or nine right off the bat.""
Patient: ""Okay.""
Therapist: ""So the garbage can I even see is a little bit dirty on the top. Not sure what these kind of smears are here. Where are your suds at now, Kate?""",139.87,142.16
089_012,089,12,2,People will probably use their feet and their shoes to open it.,"Therapist: ""You're kind of looking around. What are you observing when you're looking at it?""
Patient: ""The pedal.""
Therapist: ""Yeah. What about the pedal?""",196.51,206.71
089_014,089,14,3,"Probably like, oh, I can touch my face. I will touch my face. Like a 10.","Therapist: ""Yeah. What about the pedal?""
Patient: ""People will probably use their feet and their shoes to open it.""
Therapist: ""Where are your sleds at when you think about that?""",213.31,222.47
089_018,089,18,2,"It's not quite the ten, maybe like the nine and a half.","Therapist: ""Keep your eyes open, Kaden.""
Patient: ""It's so hot!""
Therapist: ""So you're holding this garbage can, there's some smears on the top, kind of dirty foot pedal there, who knows what's in there. Where are you at now with your sets, Kate?""",278.9,284.49
089_020,089,20,4,A little. Trying to what?,"Therapist: ""So you're holding this garbage can, there's some smears on the top, kind of dirty foot pedal there, who knows what's in there. Where are you at now with your sets, Kate?""
Patient: ""It's not quite the ten, maybe like the nine and a half.""
Therapist: ""Okay, coming down a touch?""",286.29,295.77
089_024,089,24,5,"feel it, like I can feel it on my hands, like I can just... What are you feeling on your hands? Like all the germs, all of the dirt, everything, all of the, like I can almost, it's a different feeling than prior, you know, like you can just...","Therapist: ""I gotta stay with it.""
Patient: ""Yeah.""
Therapist: ""You've got your hands on this dirty garbage can. You have that foot pedal there. There's some dirtiness and smears on the top of that.""",317.3,335.64
089_025,089,25,2,I didn't think I'd be able to do it though.,"Patient: ""Yeah.""
Therapist: ""You've got your hands on this dirty garbage can. You have that foot pedal there. There's some dirtiness and smears on the top of that.""
Patient: ""feel it, like I can feel it on my hands, like I can just... What are you feeling on your hands? Like all the germs, all of the dirt, everything, all of the, like I can almost, it's a different feeling than prior, you know, like you can just...""",343.39,346.72
089_027,089,27,4,"Nine. Okay. Okay. It still feels the same. It was hard to tell the difference between the nine and the nine and a half, I guess. Pretty high, though.","Patient: ""feel it, like I can feel it on my hands, like I can just... What are you feeling on your hands? Like all the germs, all of the dirt, everything, all of the, like I can almost, it's a different feeling than prior, you know, like you can just...""
Patient: ""I didn't think I'd be able to do it though.""
Therapist: ""So you're sitting here with a dirty garbage can, smears on the top, this kind of dirty bag here, foot pedal, who knows what feet have been on there. And you can feel those germs. Just feel them on your hand. Just be right there. Where would you say your suds are at now?""",372.37,383.44
089_029,089,29,4,it's like clammy like I can feel like almost like maybe because it's the sweaty so you can feel like my skin I'm itchy and I just want my hairs in my face but I can't touch my face I'm aware of that yeah cuz I will transfer it I know I'll transfer it feels like I'll transfer it,"Therapist: ""So you're sitting here with a dirty garbage can, smears on the top, this kind of dirty bag here, foot pedal, who knows what feet have been on there. And you can feel those germs. Just feel them on your hand. Just be right there. Where would you say your suds are at now?""
Patient: ""Nine. Okay. Okay. It still feels the same. It was hard to tell the difference between the nine and the nine and a half, I guess. Pretty high, though.""
Therapist: ""What's that feeling on your hands like right now?""",395.57,418.95
089_031,089,31,2,"Probably like that nine, eight and a half. I don't feel as hot as I was feeling a little bit ago. I think that's kind of helping. It's easy to go back up though.","Therapist: ""What's that feeling on your hands like right now?""
Patient: ""it's like clammy like I can feel like almost like maybe because it's the sweaty so you can feel like my skin I'm itchy and I just want my hairs in my face but I can't touch my face I'm aware of that yeah cuz I will transfer it I know I'll transfer it feels like I'll transfer it""
Therapist: ""Where are your suds at now?""",431.96,449.99
089_033,089,33,2,you're looking at it what are you seeing trying to figure out they're clearly fingerprints with something like food uh i'm thinking like cream cheese yeah something somebody was eating yeah whatever there's something really big right there oh people are gross it's like you can see what they've been eating,"Therapist: ""Where are your suds at now?""
Patient: ""Probably like that nine, eight and a half. I don't feel as hot as I was feeling a little bit ago. I think that's kind of helping. It's easy to go back up though.""
Therapist: ""Is it?""",456.54,485.29
089_035,089,35,4,I know. And I can know there's stuff in it.,"Therapist: ""Is it?""
Patient: ""you're looking at it what are you seeing trying to figure out they're clearly fingerprints with something like food uh i'm thinking like cream cheese yeah something somebody was eating yeah whatever there's something really big right there oh people are gross it's like you can see what they've been eating""
Therapist: ""And here it is right on your lap.""",487.3,490.11
089_039,089,39,2,Back to the nine probably. Okay. Thinking about what's in it. Mm-hmm. Bet you it's yogurt.,"Therapist: ""Where are you at? Where are you at now?""
Patient: ""I'm at the level.""
Therapist: ""What would it be at?""",501.38,510.6
089_042,089,42,2,"Oh, maybe eight and a half.","Patient: ""Back to the nine probably. Okay. Thinking about what's in it. Mm-hmm. Bet you it's yogurt.""
Therapist: ""Mm-hmm.""
Therapist: ""So some sort of mystery substances on the top. Something's in there. We've got the foot pedal and things like that. Where are you at now?""",546.91,549.07
089_050,089,50,2,I'm just trying to figure it out. What is it about it? Why is it so gross? Why?,"Therapist: ""An eight? Kind of a solid eight?""
Patient: ""Yeah.""
Therapist: ""Okay. Still sitting there with the, nothing's changed too much, just all the mystery things on the top there, that one in particular. Foot pedal and that. I see you kind of turning it. What are you seeing?""",628.75,635.62
089_053,089,53,5,Probably like a seven and a half.,"Patient: ""I'm just trying to figure it out. What is it about it? Why is it so gross? Why?""
Therapist: ""Don't get too stuck in all that kind of thing. Just stick with the fact that it's there. Just on your lap there.""
Therapist: ""Where do you think you're at now?""",660.03,676.93
089_058,089,58,2,The pitch of the liquor. licking of the lid and then like trying to open it and then touching and then putting the spoon in the garbage.,"Therapist: ""Okay. What are you thinking about right now?""
Patient: ""Again, it's the yogurt.""
Therapist: ""Yeah.""",682.32,692.83
090_001,090,1,1,I think I'm down to about a four.,"Therapist: ""Okay Kate, we're about 20 minutes into it here. Where are your suds at now?""",11.11,13.89
090_003,090,3,1,I feel proud.,"Therapist: ""Okay Kate, we're about 20 minutes into it here. Where are your suds at now?""
Patient: ""I think I'm down to about a four.""
Therapist: ""About a four. Yeah. Okay. So let's kind of officially say the Explore the Work is over and I'll take this off now. Yeah. And wow, take a deep breath. Oh, you did it. I did it. Oh my goodness. How do you feel?""",32.41,34.64
090_005,090,5,1,I feel proud. I don't think I ever would have thought I could have done that.,"Therapist: ""About a four. Yeah. Okay. So let's kind of officially say the Explore the Work is over and I'll take this off now. Yeah. And wow, take a deep breath. Oh, you did it. I did it. Oh my goodness. How do you feel?""
Patient: ""I feel proud.""
Therapist: ""Excellent.""",35.44,39.33
090_009,090,9,2,"It's a feeling of relief. Yeah. Yeah. I mean, I'm shooken up still. It's a lot, but I did it. I can do it. And I got through it. Fantastic. Yeah. Yeah.","Therapist: ""You couldn't have done that?""
Patient: ""Yeah.""
Therapist: ""Tell me about that proud. Where are you feeling that in your body? What's that like for you?""",45.2,60.75
090_011,090,11,4,"That I did not freak out. I thought I would bolt. I thought I would completely cry, not be able to get it back together. I know I felt the tears. They, you know, they weren't, I mean, I know I was at a 10, but I wasn't like losing it. The crying and all of that. I didn't bolt. It wasn't, I don't want to say hard, but it It wasn't impossible.","Therapist: ""Tell me about that proud. Where are you feeling that in your body? What's that like for you?""
Patient: ""It's a feeling of relief. Yeah. Yeah. I mean, I'm shooken up still. It's a lot, but I did it. I can do it. And I got through it. Fantastic. Yeah. Yeah.""
Therapist: ""Yeah. I mean, if it might, you did it for sure. And I just want to show you kind of what happened. So right away in that first, even 30 seconds, you spiked to an eight or nine. And then after that minute, it got up to the 10, so right up to the top. So you were very anxious. Yeah. And I kind of saw it all over your body and your breathing. and really it stayed up pretty high for those first you know almost 10 minutes at about the eight nine minute mark it started to kind of notch down 7.5 kind of after that yeah and then over those next 10 minutes it slowly kind of went down down out until you got to that four at about the 20 minute mark right now so that is what we typically see with people in this exercise. Yeah. And you had that fear that, you know, I would kind of fall apart if you encountered, you know, that germ and contamination and stuff like that. What did you learn about yourself?""",120.65,150.34
090_013,090,13,2,"It wasn't impossible. Oh, excellent. It wasn't possible.","Therapist: ""Yeah. I mean, if it might, you did it for sure. And I just want to show you kind of what happened. So right away in that first, even 30 seconds, you spiked to an eight or nine. And then after that minute, it got up to the 10, so right up to the top. So you were very anxious. Yeah. And I kind of saw it all over your body and your breathing. and really it stayed up pretty high for those first you know almost 10 minutes at about the eight nine minute mark it started to kind of notch down 7.5 kind of after that yeah and then over those next 10 minutes it slowly kind of went down down out until you got to that four at about the 20 minute mark right now so that is what we typically see with people in this exercise. Yeah. And you had that fear that, you know, I would kind of fall apart if you encountered, you know, that germ and contamination and stuff like that. What did you learn about yourself?""
Patient: ""That I did not freak out. I thought I would bolt. I thought I would completely cry, not be able to get it back together. I know I felt the tears. They, you know, they weren't, I mean, I know I was at a 10, but I wasn't like losing it. The crying and all of that. I didn't bolt. It wasn't, I don't want to say hard, but it It wasn't impossible.""
Therapist: ""It wasn't impossible.""",152.09,154.77
090_015,090,15,1,"I think it's a lot more manageable than I think. A lot more manageable than I think. Excellent. Okay. Not... It's scary, it's not as scary.","Therapist: ""It wasn't impossible.""
Patient: ""It wasn't impossible. Oh, excellent. It wasn't possible.""
Therapist: ""So what does, you know, so it was hard, you felt the tears, you didn't bolt, you sort of stuck with it. What does that say about this fear of yours?""",164.14,179.71
090_019,090,19,3,"I think so. I mean, it'll be tough, but I know how important it is.","Therapist: ""Okay, fantastic. So what we do from here now, Kate, is we send you home with this. So we have to be quite rigorous and quite disciplined to practice this. OCD is a pretty tenacious kind of disorder to have and so we really have to work at this. So what I'd encourage you to do is I'll send you home with some of these tracking sheets and every day, sit with the garbage can on your lap until, so you watch it go up and come down and then once it comes down to that, you know, 30, 40 or at least half of what it kind of peaked at, then it's done and you can kind of journal on it.""
Patient: ""Okay.""
Therapist: ""And the idea will be that eventually, we'll kind of stick with this one until it gets to the point where you don't even spike with it and then we'll move up the ladder. Okay. Does that sound doable? Yeah, I think so.""",227.47,231.22
091_001,091,1,2,"It was hard. It was definitely tough. You know, I'm working really hard on completing my homework assignments, so staying on top of it was a little bit harder, but it was really, it was interesting. I'm not... My sleep isn't as good as maybe I thought it was. I thought maybe I was having better sleeping, maybe just because I'm feeling better.","Therapist: ""Okay, Kate. So, last week we talked about sleep and the importance of sleep within to kind of, um, level things out when we're feeling a little bit more kind of elevated in terms of that manic phase of the bipolar but also how important it is to just maintain good sleep when we're when we're feeling a little bit more level just because sleep can also trigger mania or depression so sleep's really critical so what we did last week as you'll recall is i sent you home with this sleep diary right and you have to spill it out every day right So here it is, and you did a great job. It's all completed. First off, even before we kind of look at this, what was it like to take this home and to fill this out?""",44.99,66.12
091_003,091,3,2,I guess just sitting down and doing it and actually confronting my own behavior was sort of tough for me.,"Therapist: ""Okay, Kate. So, last week we talked about sleep and the importance of sleep within to kind of, um, level things out when we're feeling a little bit more kind of elevated in terms of that manic phase of the bipolar but also how important it is to just maintain good sleep when we're when we're feeling a little bit more level just because sleep can also trigger mania or depression so sleep's really critical so what we did last week as you'll recall is i sent you home with this sleep diary right and you have to spill it out every day right So here it is, and you did a great job. It's all completed. First off, even before we kind of look at this, what was it like to take this home and to fill this out?""
Patient: ""It was hard. It was definitely tough. You know, I'm working really hard on completing my homework assignments, so staying on top of it was a little bit harder, but it was really, it was interesting. I'm not... My sleep isn't as good as maybe I thought it was. I thought maybe I was having better sleeping, maybe just because I'm feeling better.""
Therapist: ""So you said, I want to get to that, but you said it was hard. What was hard about it to complete it?""",73.27,82.81
091_007,091,7,2,"Yeah, I really enjoyed it. don't get as many hours as I kind of thought that I was going to be getting.","Therapist: ""Kind of bringing yourself to looking at yourself. To look at it, yeah. Yeah, yeah, yeah. And I also just want to note, you said that you are working really hard to complete it, and you completed this one. So maybe later on in the session, we can just talk about the amazing strength it took to do that. That's really remarkable. We have to remember to put those kind of awesome things on our agenda. So let's do that after this. Is that okay?""
Patient: ""I was pretty proud of myself.""
Therapist: ""Yeah, because this is great. Okay. Alright, so back to the task at hand. So you said it was hard, just kind of seeing it here, and you kind of already took a step towards my next question. What did you notice in doing this, you know, globally? And then we can take a look at the details here.""",120.04,127.05
091_011,091,11,4,And I think there was really only the one night that I got six hours.,"Therapist: ""Okay. So how many did you think you were getting?""
Patient: ""I thought at least six.""
Therapist: ""At least six. Yeah. Okay. Yeah.""",133.26,137.42
091_013,091,13,4,Yeah. Right? Yeah. About that. Maybe five.,"Therapist: ""At least six. Yeah. Okay. Yeah.""
Patient: ""And I think there was really only the one night that I got six hours.""
Therapist: ""Saturday night you got six hours. Yeah. And the other ones, it looked like you maybe averaged out about four and a half.""",142.41,144.78
091_015,091,15,2,"Between the four and five seemed to be the average. Yeah. That's not very much sleep. It's not a lot and I think because I'm feeling good, it felt like more. So it was kind of a little confusing to see that it wasn't that much.","Therapist: ""Saturday night you got six hours. Yeah. And the other ones, it looked like you maybe averaged out about four and a half.""
Patient: ""Yeah. Right? Yeah. About that. Maybe five.""
Therapist: ""Yeah. Yeah.""",145.48,160.25
091_019,091,19,2,"Um, I guess just that, like I stay up really late and I'm up really early. Yeah. Yeah. So there was, yeah, that's like a 3am night, 2.30, 1, 3.","Therapist: ""And when you're in that really nice stable place, how much sleep do you kind of need in general?""
Patient: ""Probably like seven.""
Therapist: ""Oh, seven. Yeah. Yeah. So five is quite a bit less than that. Yeah. Yeah. Okay. All right. So first you notice it was hard. Then you kind of notice, wow, I'm not getting as much sleep as I thought I was getting. Right. Anything else that you noticed?""",182.04,195.39
091_021,091,21,4,"Oh, that was tough. Yeah, I was late. The one day it was okay because there was like another meeting, so people didn't notice that I kind of came in late. But then, and so it didn't impact me greatly there. Right. Um, but then the Saturday I, I kind of slept in and I missed, I missed a lunch date with a friend. Okay.","Therapist: ""Oh, seven. Yeah. Yeah. So five is quite a bit less than that. Yeah. Yeah. Okay. All right. So first you notice it was hard. Then you kind of notice, wow, I'm not getting as much sleep as I thought I was getting. Right. Anything else that you noticed?""
Patient: ""Um, I guess just that, like I stay up really late and I'm up really early. Yeah. Yeah. So there was, yeah, that's like a 3am night, 2.30, 1, 3.""
Therapist: ""Yeah. Yeah. And then I know that you're still getting to work. So that, you know, I'm seeing here you got 7, 7.45, so that's pretty good. But then there's a 9 a.m. and an 11 a.m. What happened on those days with work?""",206.06,226.87
091_023,091,23,5,"It's, it's definitely impacting it and I'm, I'm missing, it's not even necessarily that I'm missing so much, but then there's that like guilt, right? So like it didn't necessarily impact me at work. But I was aware that I was late. Yes, you're aware of it. And then that guilt and feeling like, am I going to start messing up again?","Therapist: ""Yeah. Yeah. And then I know that you're still getting to work. So that, you know, I'm seeing here you got 7, 7.45, so that's pretty good. But then there's a 9 a.m. and an 11 a.m. What happened on those days with work?""
Patient: ""Oh, that was tough. Yeah, I was late. The one day it was okay because there was like another meeting, so people didn't notice that I kind of came in late. But then, and so it didn't impact me greatly there. Right. Um, but then the Saturday I, I kind of slept in and I missed, I missed a lunch date with a friend. Okay.""
Therapist: ""Okay. Okay. So it's starting to, how would you kind of talk about then, um, the way sleep is impacting your life and your schedule right now?""",236.28,254.61
091_025,091,25,2,"Are things going to... Right. Am I going to get back into this pattern of, you know, staying up way too late and missing work and blowing off friends again? So I started getting really anxious about all that.","Therapist: ""Okay. Okay. So it's starting to, how would you kind of talk about then, um, the way sleep is impacting your life and your schedule right now?""
Patient: ""It's, it's definitely impacting it and I'm, I'm missing, it's not even necessarily that I'm missing so much, but then there's that like guilt, right? So like it didn't necessarily impact me at work. But I was aware that I was late. Yes, you're aware of it. And then that guilt and feeling like, am I going to start messing up again?""
Therapist: ""Sure.""",254.75,265.63
091_027,091,27,2,"I'm noticing, I guess on the nights that I'm not really, really late, it seems to be my coffee intake, my caffeine seems to be pretty high.","Therapist: ""Sure.""
Patient: ""Are things going to... Right. Am I going to get back into this pattern of, you know, staying up way too late and missing work and blowing off friends again? So I started getting really anxious about all that.""
Therapist: ""Sure. And then that's a tricky little vicious cycle that can start chugging away, right? Yeah. So it's pretty important. And as we've talked about, you know, sleep is a symptom of... bipolar disorder but of course the kids right it's quite dysregulated and so it's it becomes a symptom but also you know a result so yeah coming that self-perpetuating thing so again another reason to really kind of get at this here yeah well so thank you for anything else that you kind of saw or thought about here""",295.88,305.33
091_029,091,29,2,"That's a little bit more than usual, I think, because I've been feeling really good and there's projects I'm working on, so I'm wanting to stay energized and stay on top of it. And then the result is that I'm not. Yeah, it's tough. Yeah, it's hard to kind of break that. And I think I associate the coffee with feeling good and getting stuff accomplished.","Therapist: ""Sure. And then that's a tricky little vicious cycle that can start chugging away, right? Yeah. So it's pretty important. And as we've talked about, you know, sleep is a symptom of... bipolar disorder but of course the kids right it's quite dysregulated and so it's it becomes a symptom but also you know a result so yeah coming that self-perpetuating thing so again another reason to really kind of get at this here yeah well so thank you for anything else that you kind of saw or thought about here""
Patient: ""I'm noticing, I guess on the nights that I'm not really, really late, it seems to be my coffee intake, my caffeine seems to be pretty high.""
Therapist: ""Yeah, so let's just go over that. I've got my coffee over there. But let's take a look. 10 caffeinated drinks on Monday, 6 or 7 on Tuesday, 8 on Wednesday, 10, 6, 9, and 10. Is that a lot? Is that more than usual for you?""",328.89,350.22
091_031,091,31,3,I think it's going to be really important. I don't want to slide back into this cycle of just missing things and then staying up too late and not getting enough sleep.,"Therapist: ""Yeah, so let's just go over that. I've got my coffee over there. But let's take a look. 10 caffeinated drinks on Monday, 6 or 7 on Tuesday, 8 on Wednesday, 10, 6, 9, and 10. Is that a lot? Is that more than usual for you?""
Patient: ""That's a little bit more than usual, I think, because I've been feeling really good and there's projects I'm working on, so I'm wanting to stay energized and stay on top of it. And then the result is that I'm not. Yeah, it's tough. Yeah, it's hard to kind of break that. And I think I associate the coffee with feeling good and getting stuff accomplished.""
Therapist: ""Right, right, yeah. So would you say that, you know, how important do you think it would be for you to try to start getting some better sleep? How important would that be for the overall picture for you?""",362.76,373.49
091_033,091,33,4,"Well, I kind of lay there. Like usually I have to get up and use the bathroom. Yeah. And then I get back into bed and then the brain starts.","Therapist: ""Right, right, yeah. So would you say that, you know, how important do you think it would be for you to try to start getting some better sleep? How important would that be for the overall picture for you?""
Patient: ""I think it's going to be really important. I don't want to slide back into this cycle of just missing things and then staying up too late and not getting enough sleep.""
Therapist: ""yeah so it's pretty important in the big picture right okay okay so we kind of think about that like our target behavior that we want to start thinking about the broader one would it be all right if i kind of i think build on some of the things you've talked about and then we could decide together which behavior we want to target for this week and start playing with to try to improve your sleep a little bit yeah okay so one thing you've already done yeah this was a big one for me your caffeinated drinks and again i i love my coffee but that is quite a lot of caffeine a day and so that might be an area that we think about how could we reduce that How do we cope with maybe that headache that would show up? Maybe it's just a habit to have a hot coffee at your side. Maybe there's something else that we could substitute that with. So that could be an area that we target. Another area that I was thinking about, it's really important when we're looking at sleep and sleep hygiene, and even when we do CBT for insomnia, to always have a consistent wake time. So no matter how good or bad or how many times you woke up at night, you always get up at the same time. And then also to try to aim for a somewhat consistent bedtime. Although what's more important there is to go to sleep only when you're tired and not just sleepy. So sleepy means that you're kind of, oh, I've had a long weekend feeling kind of sleepy today. Tired is when we're actually nodding off and we're yawning and fighting the war or losing the battle, I mean. So at night, you'd want to kind of think about, all right, let's aim for a reasonable bedtime, 11.30 or something like that, but not before I get kind of sleepy. Okay. And we can get into the mechanics of why that is, but there's certain kind of biological cycles that we need to pay attention to, and getting up at the same time helps, and trying to go to bed when we're sleepy or tired also will help. So that could be an area that we talk about there as well. Okay. When you woke up in the night, that's something we haven't talked about. You were up as many as six times in a night. That was on Thursday night. Yeah. When you are up at night, what do you find yourself doing?""",500.9,507.52
091_035,091,35,4,"Yeah. Thinking about everything I want to work on, everything I want to do and yeah, just kind of. hard to shut it off and get back.","Therapist: ""yeah so it's pretty important in the big picture right okay okay so we kind of think about that like our target behavior that we want to start thinking about the broader one would it be all right if i kind of i think build on some of the things you've talked about and then we could decide together which behavior we want to target for this week and start playing with to try to improve your sleep a little bit yeah okay so one thing you've already done yeah this was a big one for me your caffeinated drinks and again i i love my coffee but that is quite a lot of caffeine a day and so that might be an area that we think about how could we reduce that How do we cope with maybe that headache that would show up? Maybe it's just a habit to have a hot coffee at your side. Maybe there's something else that we could substitute that with. So that could be an area that we target. Another area that I was thinking about, it's really important when we're looking at sleep and sleep hygiene, and even when we do CBT for insomnia, to always have a consistent wake time. So no matter how good or bad or how many times you woke up at night, you always get up at the same time. And then also to try to aim for a somewhat consistent bedtime. Although what's more important there is to go to sleep only when you're tired and not just sleepy. So sleepy means that you're kind of, oh, I've had a long weekend feeling kind of sleepy today. Tired is when we're actually nodding off and we're yawning and fighting the war or losing the battle, I mean. So at night, you'd want to kind of think about, all right, let's aim for a reasonable bedtime, 11.30 or something like that, but not before I get kind of sleepy. Okay. And we can get into the mechanics of why that is, but there's certain kind of biological cycles that we need to pay attention to, and getting up at the same time helps, and trying to go to bed when we're sleepy or tired also will help. So that could be an area that we talk about there as well. Okay. When you woke up in the night, that's something we haven't talked about. You were up as many as six times in a night. That was on Thursday night. Yeah. When you are up at night, what do you find yourself doing?""
Patient: ""Well, I kind of lay there. Like usually I have to get up and use the bathroom. Yeah. And then I get back into bed and then the brain starts.""
Therapist: ""Chugging away, right?""",508.12,514.85
091_037,091,37,1,"Yeah, okay, that makes a lot of sense. Okay, all right.","Therapist: ""Chugging away, right?""
Patient: ""Yeah. Thinking about everything I want to work on, everything I want to do and yeah, just kind of. hard to shut it off and get back.""
Therapist: ""Yeah, for sure. Yeah. So that's another area that we could target. Cause I think you're just like all the rest of us. We wake up at night and you know, it's warm and cozy and you don't feel like getting up and doing anything. And yet when we lie in bed and our brain starts going, maybe we start feeling kind of anxious or agitated. Then we start kind of linking those negative emotions and physical sensations with bed. And then bed doesn't become that nice, peaceful place to go and rest. It becomes and being kind of distressed. So what we recommend for folks is if we are up in the night, to throw off the covers, go someplace, maybe dimly lit, and do something kind of low stimulation. So maybe reading kind of a dull book, a textbook or something. A crossword puzzle or something like that. Listening to some gentle music or jazz or something like that. That just sort of gets us out of bed so we're not making that link that can become a problem. So that might also be something that we look at.""",570.58,573.1
092_001,092,1,2,"What would you like to do here? Starting lower might, I guess, be easier. So I know some of the things that kind of, we talked about that, the uncertainty is hard for me is like when I'm at work and I know I've left my car in that parking lot, it's so far from the building. So, you know, I tend to use my lunch break to go and make sure that the car's there, nobody's broken in and taken anything.","Therapist: ""okay so what we're going to talk about now is kind of taking some first steps towards exposure therapy and remember exposure therapy is this idea that we're going to sort of sit with some of these anxiety provoking thoughts or experiences oh big sigh i know right um and we're going to sit with it and we're not going to do much else than that And we're going to allow our bodies to naturally habituate to the anxiety and to the discomfort that comes from that. While also learning that that kind of feared thought probably isn't going to happen. So we've done a little bit of this work. We're going to think about this uncertainty that I know is really difficult for you with your anxiety. And this thought that uncertainty is just unbearable. And if I have to kind of tolerate it, I'll fall apart. So that's what we're going to kind of experiment with and work to expose you to, okay? And remember, you'll always be in control and we're going to do this in a way that is measured and organized. You're not going to be surprised by anything so that you're very much in control, but it is going to be a challenge. You're going to be kind of pushed to face these things, okay? And the first step that we need to do to get this kind of organization going is to actually make a list, a hierarchy or a ladder of things that cause us anxiety around that thought of uncertainty and I can't bear it and I'll fall apart if I have to encounter uncertainty, okay? So if you can kind of think about those things in your life related to uncertainty that are very difficult for you, I'll just kind of prompt you a bit, think about your kids, think about kind of what you do going out and things like that to sort of help you with uncertainty. Those will be the kinds of things. And we're going to put a rating on each one from about 30 to 40% anxiety right up to kind of 100% plus, plus, plus. Right. And we don't want to do anything lower than 30 because then it's not going to be all that useful, right? Right. 20% anxiety is like, well, I could probably cope. Yeah. But we're going to look for something 30 or up. So I don't know where you want to start. Do you want to start with that 100% plus, plus, plus and work down? Do you want to start at the bottom or is there a thought even popping to mind that we could sort of put somewhere? Yeah.""",136.25,163.37
092_003,092,3,2,"Probably, yeah, around that, like, 30-40. 30-40.","Therapist: ""okay so what we're going to talk about now is kind of taking some first steps towards exposure therapy and remember exposure therapy is this idea that we're going to sort of sit with some of these anxiety provoking thoughts or experiences oh big sigh i know right um and we're going to sit with it and we're not going to do much else than that And we're going to allow our bodies to naturally habituate to the anxiety and to the discomfort that comes from that. While also learning that that kind of feared thought probably isn't going to happen. So we've done a little bit of this work. We're going to think about this uncertainty that I know is really difficult for you with your anxiety. And this thought that uncertainty is just unbearable. And if I have to kind of tolerate it, I'll fall apart. So that's what we're going to kind of experiment with and work to expose you to, okay? And remember, you'll always be in control and we're going to do this in a way that is measured and organized. You're not going to be surprised by anything so that you're very much in control, but it is going to be a challenge. You're going to be kind of pushed to face these things, okay? And the first step that we need to do to get this kind of organization going is to actually make a list, a hierarchy or a ladder of things that cause us anxiety around that thought of uncertainty and I can't bear it and I'll fall apart if I have to encounter uncertainty, okay? So if you can kind of think about those things in your life related to uncertainty that are very difficult for you, I'll just kind of prompt you a bit, think about your kids, think about kind of what you do going out and things like that to sort of help you with uncertainty. Those will be the kinds of things. And we're going to put a rating on each one from about 30 to 40% anxiety right up to kind of 100% plus, plus, plus. Right. And we don't want to do anything lower than 30 because then it's not going to be all that useful, right? Right. 20% anxiety is like, well, I could probably cope. Yeah. But we're going to look for something 30 or up. So I don't know where you want to start. Do you want to start with that 100% plus, plus, plus and work down? Do you want to start at the bottom or is there a thought even popping to mind that we could sort of put somewhere? Yeah.""
Patient: ""What would you like to do here? Starting lower might, I guess, be easier. So I know some of the things that kind of, we talked about that, the uncertainty is hard for me is like when I'm at work and I know I've left my car in that parking lot, it's so far from the building. So, you know, I tend to use my lunch break to go and make sure that the car's there, nobody's broken in and taken anything.""
Therapist: ""Okay. So if you could imagine, um, not going out at lunch to check on your car, but just sort of sitting and see your body tense up a little bit. And that's sort of a good sign for me. I know it's not easy for you, but that's a good sign that we're kind of on the right track. But if you could imagine not going out to the parking lot to check on your car at lunchtime, how much anxiety would that cause you, do you think?""",187.72,191.69
092_005,092,5,2,"Oh, well, we had that one session about I have to look at the menu before I go out. Oh, right.","Therapist: ""Okay. So if you could imagine, um, not going out at lunch to check on your car, but just sort of sitting and see your body tense up a little bit. And that's sort of a good sign for me. I know it's not easy for you, but that's a good sign that we're kind of on the right track. But if you could imagine not going out to the parking lot to check on your car at lunchtime, how much anxiety would that cause you, do you think?""
Patient: ""Probably, yeah, around that, like, 30-40. 30-40.""
Therapist: ""Okay, so let's start with that. That's kind of a perfect place to start. So 30-40% anxiety, not checking on a car. Okay. At lunchtime. Alright. Okay, what would be next? Or what would be something else that comes to mind? It doesn't have to be next.""",213.2,221.16
092_009,092,9,2,"I have to look at it so that I, you know, I'm prepared to know what to order and you can prepare any type of questions the waitress is going to ask. Right. Right. Right. Kind of prepare for it.","Therapist: ""Yes. Yeah. Yeah. Yeah. And you don't go to restaurants unless their menus are online.""
Patient: ""That's right.""
Therapist: ""Yeah.""",225.45,234.44
092_011,092,11,2,"That's a little higher than this. Okay. That's probably around like, yeah, maybe like a 45, 50. Okay.","Therapist: ""Yeah.""
Patient: ""I have to look at it so that I, you know, I'm prepared to know what to order and you can prepare any type of questions the waitress is going to ask. Right. Right. Right. Kind of prepare for it.""
Therapist: ""Yeah. Yeah. So remember when we're doing these exposures, we have kind of different options available to us. Right. So one would be to imagine, imagine, kind of going to a restaurant and we could get really clear about what that image looks like. Imagine going to a restaurant and not looking at the menu and just kind of going in there cold. What do you think imagining that scenario would be like for you?""",258.98,268.01
092_015,092,15,2,"Well, You know, a lot of the times I kind of struggle with like what's going on with the kids throughout the day. Yeah, yeah, yeah. So there's the, you can like go online and look at the cameras at the daycare.","Therapist: ""All right. So not a whole lot higher than this one, but a little bit. So imagining not checking, imagining going out, I'm just going to say going out cold. Yeah. For lack of a, sounds like you're passing out, but that's not fair. Like going out to a restaurant cold just for the interest of time. What about actually doing that? What do you think it would be like for you to actually choose a restaurant, you know, today's Friday, going out tonight, just, all right, I'm going to go there and just going without looking, without preparing.""
Patient: ""That's probably like a 70.""
Therapist: ""That's a 70. Okay. So I'm going to leave a space because we'll need something in the middle here. Okay. But 70% would be going out to eat, actually going out to eat without preparing. Right. Okay. Okay. So we've got a couple of things that are a little lower. We need something a little bit more mid range here. What do you think that might be?""",328.26,338.94
092_017,092,17,1,So I do that pretty frequently.,"Therapist: ""That's a 70. Okay. So I'm going to leave a space because we'll need something in the middle here. Okay. But 70% would be going out to eat, actually going out to eat without preparing. Right. Okay. Okay. So we've got a couple of things that are a little lower. We need something a little bit more mid range here. What do you think that might be?""
Patient: ""Well, You know, a lot of the times I kind of struggle with like what's going on with the kids throughout the day. Yeah, yeah, yeah. So there's the, you can like go online and look at the cameras at the daycare.""
Therapist: ""At the daycare, that's right.""",340.96,343.18
092_019,092,19,1,Usually twice a day. Okay. Sometimes three.,"Therapist: ""At the daycare, that's right.""
Patient: ""So I do that pretty frequently.""
Therapist: ""Okay. How frequently would you do that?""",347.29,350.73
092_023,092,23,1,"Right. I think imagining not checking would be like you said, that lower, like the 20. So down here.","Therapist: ""Okay, two or three times a day.""
Patient: ""Yeah.""
Therapist: ""So we've got some options there, right? We could either do it where we kind of... we could imagine, again, not checking. If you kind of think about that, what does that do for our hierarchy here? Let me give you the options. So you could imagine not checking, or we could start playing with only checking twice only checking once, like for real, in vivo, actually doing it. So it could be kind of chipping away at that one, two, three, to the point where you're not checking on them at all.""",381.54,387.39
092_025,092,25,2,"Yeah. So, but the actually not checking would be a bit higher.","Therapist: ""So we've got some options there, right? We could either do it where we kind of... we could imagine, again, not checking. If you kind of think about that, what does that do for our hierarchy here? Let me give you the options. So you could imagine not checking, or we could start playing with only checking twice only checking once, like for real, in vivo, actually doing it. So it could be kind of chipping away at that one, two, three, to the point where you're not checking on them at all.""
Patient: ""Right. I think imagining not checking would be like you said, that lower, like the 20. So down here.""
Therapist: ""Yeah. Okay. All right. So that's off.""",389.23,393.96
092_027,092,27,2,"So for me, checking after their naps is really important because I just, you know, the SIDS stuff kind of goes in the back of my head. So I like to make sure that they've gotten up from their nap and they're okay.","Therapist: ""Yeah. Okay. All right. So that's off.""
Patient: ""Yeah. So, but the actually not checking would be a bit higher.""
Therapist: ""Okay. Can you help me kind of understand how?""",397.45,412.0
092_029,092,29,2,"So not checking after that nap to me is like, feels like an 80, 90.","Therapist: ""Okay. Can you help me kind of understand how?""
Patient: ""So for me, checking after their naps is really important because I just, you know, the SIDS stuff kind of goes in the back of my head. So I like to make sure that they've gotten up from their nap and they're okay.""
Therapist: ""Right.""",412.52,417.05
092_033,092,33,1,"After nap. And then like the other one or two times a day would probably could fill that space there that maybe reducing the, like the morning checking.","Therapist: ""That'd be up here. Yeah. Okay. So could I put that up here?""
Patient: ""Yeah.""
Therapist: ""8% to 90%. Not checking after nap.""",425.76,435.25
092_035,092,35,2,Cause then I have to go all the way until. Sure. So that uncertainty from when I drop them off until after nap. Right. Sure.,"Therapist: ""8% to 90%. Not checking after nap.""
Patient: ""After nap. And then like the other one or two times a day would probably could fill that space there that maybe reducing the, like the morning checking.""
Therapist: ""Okay. So it could be saying not checking you in the morning, but still checking you after nap. That would be this one. Yes. Okay. Yes.""",441.93,450.36
092_037,092,37,2,Yes. Without. In the cold.,"Therapist: ""Okay. So it could be saying not checking you in the morning, but still checking you after nap. That would be this one. Yes. Okay. Yes.""
Patient: ""Cause then I have to go all the way until. Sure. So that uncertainty from when I drop them off until after nap. Right. Sure.""
Therapist: ""Yeah. Okay. So just to recap, we've got these kind of two lower ones. They're almost the same, but we could see about that. So not checking on your car at lunch, actually not checking, that would be an in vivo exposure. An imaginal exposure would be imagining, I said going out cold, right? But going out to eat.""",471.79,474.59
092_039,092,39,2,yeah that's at the top as i say that yeah yeah that'd be tough yeah okay um anything that would you can imagine giving you 100 you know right off the charts yeah something probably the days where i go out after work and the kids are are with like my in-laws or something um and just having no contact like not knowing how they're doing until I get home sure and having that that would be off the chart like going the entire day cuz done that'll be like after I get home would be like they've been to bed okay okay all right so let's play with that a little bit and this is sort of where the technical stuff comes so these are types of things that we need to be able to kind of sit with and,"Therapist: ""Yeah. Okay. So just to recap, we've got these kind of two lower ones. They're almost the same, but we could see about that. So not checking on your car at lunch, actually not checking, that would be an in vivo exposure. An imaginal exposure would be imagining, I said going out cold, right? But going out to eat.""
Patient: ""Yes. Without. In the cold.""
Therapist: ""Without checking. Without prepping, right? Right. Okay. Okay. okay and then we have this one here um you're not checking in the morning on the kids i'm going to just get clear because i'm going to write these down okay but still checking after their nap and then you're actually going to go out without preparing yeah instead of just imagining it this is an in vivo imaginable and then this would be not checking at all after now that's an individual one okay so then this one would that mean i haven't checked all day this would mean you wouldn't check all day okay""",506.94,554.7
092_041,092,41,4,"Yeah, yeah, something's happened to the kids.","Therapist: ""Without checking. Without prepping, right? Right. Okay. Okay. okay and then we have this one here um you're not checking in the morning on the kids i'm going to just get clear because i'm going to write these down okay but still checking after their nap and then you're actually going to go out without preparing yeah instead of just imagining it this is an in vivo imaginable and then this would be not checking at all after now that's an individual one okay so then this one would that mean i haven't checked all day this would mean you wouldn't check all day okay""
Patient: ""yeah that's at the top as i say that yeah yeah that'd be tough yeah okay um anything that would you can imagine giving you 100 you know right off the charts yeah something probably the days where i go out after work and the kids are are with like my in-laws or something um and just having no contact like not knowing how they're doing until I get home sure and having that that would be off the chart like going the entire day cuz done that'll be like after I get home would be like they've been to bed okay okay all right so let's play with that a little bit and this is sort of where the technical stuff comes so these are types of things that we need to be able to kind of sit with and""
Therapist: ""in a contained period of time. When we do these exposures, what we often see is that a person's anxiety will spike and then come back down just naturally over about 20 to 25 minutes, sometimes 30. Doing, you know, I think all of these would kind of fit that criterion. Doing that with your kids all day long would be tough because that would be a whole day where you're kind of just sitting with that anxiety. So I wonder, we could do a couple things with that. One would be that you just imagine it. Yeah. As a first step. Okay. Another one would be, I'm kind of hearing playing in the background of that, this thought that's kind of the ultimate thought of, you know, something could go wrong.""",596.53,598.69
092_045,092,45,2,"Yeah, especially if it's something, you know, the possibility that something's going to happen to the kids.","Therapist: ""Something's happened, something could go wrong, right? And so, you know, it doesn't sound like much, but actually sitting with that thought and almost repeating it to ourselves and kind of heightening our awareness of that, you know, something could go wrong. I don't know what's happening with the kids right now. Something good, something bad, I just don't know. Sometimes that can be a really powerful exposure in and of itself just to that thought.""
Patient: ""Yeah.""
Therapist: ""Do you think that would get you 100%? Especially if we focus it on the kids?""",627.9,632.21
093_003,093,3,2,"So that's, for me, a lot of that tension.","Therapist: ""All right, Kate, so we're working with anger today, right? And what can be really important is remembering that when we get to that kind of peak of anger, we're seeing red, all bets are off, right? That's just sort of how it goes. Our frontal cortex kind of turns off. We're totally engaging with like lower, more primitive parts of our brain. It's just, it's really difficult. So the idea with working with our anger is try to kind of get on top of it, nip it in the bud before it gets to that peak. eruption point right and so it can be really useful for us to know what our cues are we'll know what kind of those little red flags are that start popping up so that if we start seeing them we can take some steps to calm down a little bit so I'm wondering if we could spend a little bit of time here just thinking about what those cues could be and turning our attention to that good old kind of those categories of the five-factor model to try to understand right okay so what are our thoughts or our images kind of those cognitions up and often it's not going to be anger but those moods underneath the anger that we're going to want to talk about. What kind of things do we start doing that are cues that our anger is getting out of control and how does our body respond? Where do you want to start?""
Patient: ""Maybe the physical.""
Therapist: ""Physical, yeah. We often feel it there pretty quick.""",86.66,88.81
093_007,093,7,2,"I get, like, really clenched fists. Clenched fists? Or, like, white-knuckling when I'm diving.","Therapist: ""Okay, specific. Where do you feel the tension?""
Patient: ""In my, like, shoulders and my neck.""
Therapist: ""Tension in shoulders and neck. What else?""",100.78,108.72
093_011,093,11,2,"Hot, hot, hot. And that's probably red face.","Therapist: ""White-knuckling it. Yeah. Okay. Okay.""
Patient: ""I get a lot of headaches. Okay.""
Therapist: ""Get really hot.""",119.71,122.6
093_013,093,13,1,That one's easy. That one's easy. That's what started there.,"Therapist: ""Get really hot.""
Patient: ""Hot, hot, hot. And that's probably red face.""
Therapist: ""Yeah. And those often show up right in the moment, right? When we get that rush of heat. Yes. Yeah. Okay. Okay. That's a pretty great list. Nice, nice clear list there. Yeah.""",131.87,134.23
093_015,093,15,2,"Um, I guess for me the behaviors. Yeah. A lot of the yelling. Okay. Swearing. Uh huh. I'm like a cruncher, so I stop throwing things, but I smush things or tear things up instead of smashing.","Therapist: ""Yeah. And those often show up right in the moment, right? When we get that rush of heat. Yes. Yeah. Okay. Okay. That's a pretty great list. Nice, nice clear list there. Yeah.""
Patient: ""That one's easy. That one's easy. That's what started there.""
Therapist: ""Okay. What else is, what else is there? Where else should we go?""",138.64,161.28
093_019,093,19,2,"Not really, like angry texts.","Therapist: ""Smush, that's a word I don't spell very often. Yeah, smush things. Smush and scrunch. And scrunch. Okay, I'll do my best with that one. Scrunch and smush. Okay, so you're... Yeah. Yeah, that sounds like it's going to born out of that tension.""
Patient: ""Yeah.""
Therapist: ""All right. So yelling, swearing, smushing, and scrunching. Yeah. Okay. Other, anything else here?""",182.35,188.62
093_023,093,23,2,"Yeah, it makes me uncomfortable. A little uncomfortable. Yeah. It comes quick. I find it's right there. It's so accessible. Sure. Okay. All right. Where to next, Kate? I guess the moods.","Therapist: ""Okay. Texting. Yeah. Okay.""
Patient: ""But. Those are the big ones.""
Therapist: ""I find the swearing and the yelling. Even as we are talking about it, how does that make you feel?""",199.78,213.68
093_025,093,25,5,I think after kind of the anger is a lot of that sadness.,"Therapist: ""I find the swearing and the yelling. Even as we are talking about it, how does that make you feel?""
Patient: ""Yeah, it makes me uncomfortable. A little uncomfortable. Yeah. It comes quick. I find it's right there. It's so accessible. Sure. Okay. All right. Where to next, Kate? I guess the moods.""
Therapist: ""Okay. What over here?""",214.76,221.35
093_027,093,27,2,"Probably, probably. It's so hard to pay attention to that. So I'm only usually aware of it after it's all over.","Therapist: ""Okay. What over here?""
Patient: ""I think after kind of the anger is a lot of that sadness.""
Therapist: ""Right. And you say after, do you suppose there's any sadness underneath the anger leading up?""",227.96,235.77
093_029,093,29,2,"But usually the things that kind of are coming beforehand are things that have, yeah, kind of made me feel.","Therapist: ""Right. And you say after, do you suppose there's any sadness underneath the anger leading up?""
Patient: ""Probably, probably. It's so hard to pay attention to that. So I'm only usually aware of it after it's all over.""
Therapist: ""Right.""",236.87,241.75
093_033,093,33,4,"Sort of that, like, it's not fair.","Therapist: ""Okay. Maybe we'll have to pay a little attention to that as we move forward, right? But maybe there's some sadness there underneath that anger. Frustration. Frustration, sure. That's kind of along that spectrum of what anger is, yeah?""
Patient: ""Yeah.""
Therapist: ""Anything else? Guilt. Guilt, sure. so some sadness frustration guilt those are those kind of softer actually more difficult emotions sometimes yeah anger right okay finally what about this whole cognition thought area what's up here the why me why me why me okay it seems to be there a lot uh-huh okay um these ones are harder definitely kind of""",297.43,299.53
093_036,093,36,4,"Yeah. Well, why does everything happen to me? Why, you know...","Patient: ""Sort of that, like, it's not fair.""
Unknown: ""Okay.""
Therapist: ""Okay. If you could answer, why me? Why you?""",313.87,319.01
093_040,093,40,5,It's never easy. It's hard for me all the time. It's just hard. Everything's difficult.,"Therapist: ""So, everything happens to me.""
Patient: ""Everything happens to me, yeah.""
Therapist: ""Okay.""",324.48,329.92
093_042,093,42,4,"Remember, nothing goes my way. Nothing goes my way, okay. Seems like the world is out to get me.","Therapist: ""Okay.""
Patient: ""It's never easy. It's hard for me all the time. It's just hard. Everything's difficult.""
Therapist: ""So everything's hard, everything's difficult.""",335.83,343.42
093_044,093,44,4,Right. Yeah. Yeah. Before the smushing and scrunching happens. That's right. All right.,"Therapist: ""So everything's hard, everything's difficult.""
Patient: ""Remember, nothing goes my way. Nothing goes my way, okay. Seems like the world is out to get me.""
Therapist: ""The world is out to get you, okay. Okay. So here is your kind of symptom fingerprint, right? The way things look for you, Kate, when anger comes up for you, here's what shows up for moods, behaviors, response, physical responses, and our thoughts. And I suppose our job is to kind of figure out what to do with all this before it reaches that boiling point.""",367.47,371.75
094_001,094,1,4,"Well, it seems really rigid.","Therapist: ""Okay Kate, so we've done some of that work around these situations where you feel, you know, very tempted to drink. And we've done that work now to identify the hot thought, I need alcohol to function, right? And so let's take a look at this thought and try to kind of unpack it and see if we can restructure it and think about it in a different way. Kind of with the idea that it'll help you out in these times when maybe you're faced with a temptation or, you know, kind of that desire to drink and what you can tell yourself or even tell yourself more broadly, globally, about, you know, the way alcohol impacts your life. Okay? Okay. So, just even at first blush, you know, I need alcohol to function. What do you think of that thought?""",45.31,48.44
094_003,094,3,1,"Well, it's just kind of, it seems like a statement, like there's no room to move within it. It's kind of like that, the cognitive distortion, like if it's really black or white. Black and white. Kind of like all or nothing, right? Yeah. Like it's, I always need it. Right. Kind of all or nothing. All or nothing. Okay.","Therapist: ""Okay Kate, so we've done some of that work around these situations where you feel, you know, very tempted to drink. And we've done that work now to identify the hot thought, I need alcohol to function, right? And so let's take a look at this thought and try to kind of unpack it and see if we can restructure it and think about it in a different way. Kind of with the idea that it'll help you out in these times when maybe you're faced with a temptation or, you know, kind of that desire to drink and what you can tell yourself or even tell yourself more broadly, globally, about, you know, the way alcohol impacts your life. Okay? Okay. So, just even at first blush, you know, I need alcohol to function. What do you think of that thought?""
Patient: ""Well, it seems really rigid.""
Therapist: ""Yeah. Yeah. It's sort of like... It captures. Mm-hmm. Okay. What about it seems rigid?""",57.81,75.44
094_006,094,6,1,to functions to sort of go about my daily life. Go about daily life.,"Patient: ""Well, it's just kind of, it seems like a statement, like there's no room to move within it. It's kind of like that, the cognitive distortion, like if it's really black or white. Black and white. Kind of like all or nothing, right? Yeah. Like it's, I always need it. Right. Kind of all or nothing. All or nothing. Okay.""
Unknown: ""Okay.""
Therapist: ""even kind of added almost kind of a thought that's in the background of this one I always need it right so if we do kind of go down that path if we push away from this idea that it's black and white or all or nothing what you know what do we think about maybe what we should do is let's think about functioning here so what does that mean to you to function well yeah I guess I""",102.11,106.01
094_010,094,10,2,Sounds really extreme. Sounds extreme.,"Therapist: ""Okay. Maybe I'll kind of put that here.""
Patient: ""Okay.""
Therapist: ""Go about daily life. And so if you kind of put it here, I need alcohol to go about my daily life. You kind of rephrase it a little bit. How does that sound to you?""",125.98,128.08
094_012,094,12,2,"Well, it's sort of before all this, like, divorce stuff happened. Sure. I mean, I was, I wasn't, my drinking was nowhere out of control.","Therapist: ""Go about daily life. And so if you kind of put it here, I need alcohol to go about my daily life. You kind of rephrase it a little bit. How does that sound to you?""
Patient: ""Sounds really extreme. Sounds extreme.""
Therapist: ""Yeah. Has there ever been a time when even a day or an hour, part of a day, or even a period of your life where you were able to go about your daily life without alcohol? Yeah. When was that?""",143.3,151.33
094_016,094,16,2,"I mean, maybe more like social function. Social function.","Therapist: ""Right.""
Patient: ""The way it is now.""
Therapist: ""Right. So before your divorce, before all this, I know it's a really hard time for you right now, but before all of that, you know, you didn't need it. No. Right.""",162.43,165.28
094_018,094,18,2,"Right. So, yeah, I didn't need it. Yeah.","Therapist: ""Right. So before your divorce, before all this, I know it's a really hard time for you right now, but before all of that, you know, you didn't need it. No. Right.""
Patient: ""I mean, maybe more like social function. Social function.""
Therapist: ""Okay. Okay. But, you know, you define functioning as going about your daily life.""",169.64,171.79
094_024,094,24,4,"Yeah, I was. I mean, I can go about it. It's just seems to be very difficult. Okay. So it's the bad days. Yeah.","Therapist: ""Yeah. Okay. Okay. Um, and you said, have there been any other times? So like we could say pre, pre-divorce, this was true. Yeah. Even in these days, you know, I know you're kind of working with it. There have been times when you've tried to go.""
Patient: ""Yeah.""
Therapist: ""Were you able to go about your daily life?""",230.96,238.98
094_028,094,28,1,"Well, just need. I mean, it's putting that it's very narrow. That's it's very narrow. It's saying that I'm unable to do it without. Right. But that's, it's not necessarily true.","Therapist: ""Okay. So what that sort of speaks to me is this idea of this word here.""
Patient: ""Yeah. Yeah.""
Therapist: ""You kind of resonate. Why are you going? Yeah.""",246.77,257.47
094_030,094,30,4,"Well, I just, I guess, I guess it's more like the alcohol sort of maybe in my mind it's like it makes things easier or I don't know sure it reduces sort of the intensity of those days when I'm not drinking sure so maybe it's more like maybe a little bit more circumstantial or something like it's and how does that play into this help me kind of connect those dots between your line of thought well I guess what I was thinking about are like you know, when I'm like really sad or really angry or those emotions that are hard to manage is, is more of the times I feel like I'm really needing the alcohol.","Therapist: ""You kind of resonate. Why are you going? Yeah.""
Patient: ""Well, just need. I mean, it's putting that it's very narrow. That's it's very narrow. It's saying that I'm unable to do it without. Right. But that's, it's not necessarily true.""
Therapist: ""Right. Right. So the word need is too narrow. Yeah. I'm going to kind of do this. Need is too narrow. Okay. All right. So we've kind of looked at kind of the cognitive distortions that might be a part of this. It's rigid, it's black and white, all or nothing. We've kind of looked at some evidence that says, oh yeah, you know, there was periods of my life pre-divorce where I didn't I didn't use it in the way I'm using it now. And now even this, you know, you're thinking about periods even currently where you're able to focus. We both kind of landed on that idea of need. Need is too narrow. Right. Right? Anything else come to mind? How to kind of think about this differently or what to consider with this thought?""",305.37,350.35
094_032,094,32,2,"Yeah. How is that important? Well, I think it's, I guess kind of like more so coping.","Therapist: ""Right. Right. So the word need is too narrow. Yeah. I'm going to kind of do this. Need is too narrow. Okay. All right. So we've kind of looked at kind of the cognitive distortions that might be a part of this. It's rigid, it's black and white, all or nothing. We've kind of looked at some evidence that says, oh yeah, you know, there was periods of my life pre-divorce where I didn't I didn't use it in the way I'm using it now. And now even this, you know, you're thinking about periods even currently where you're able to focus. We both kind of landed on that idea of need. Need is too narrow. Right. Right? Anything else come to mind? How to kind of think about this differently or what to consider with this thought?""
Patient: ""Well, I just, I guess, I guess it's more like the alcohol sort of maybe in my mind it's like it makes things easier or I don't know sure it reduces sort of the intensity of those days when I'm not drinking sure so maybe it's more like maybe a little bit more circumstantial or something like it's and how does that play into this help me kind of connect those dots between your line of thought well I guess what I was thinking about are like you know, when I'm like really sad or really angry or those emotions that are hard to manage is, is more of the times I feel like I'm really needing the alcohol.""
Therapist: ""Right. Oh, I see. I see. Okay. So it's not like an all the time thing. Right. But it's when emotions are a little bit. Yeah. Okay.""",357.9,366.79
094_034,094,34,4,"And, when the emotions are so strong, like I feel like I can't function. And then that's kind of where I land on.","Therapist: ""Right. Oh, I see. I see. Okay. So it's not like an all the time thing. Right. But it's when emotions are a little bit. Yeah. Okay.""
Patient: ""Yeah. How is that important? Well, I think it's, I guess kind of like more so coping.""
Therapist: ""Uh huh.""",369.55,375.37
094_038,094,38,1,"Well, I would definitely tell them that they don't, and I think that it may feel like they do, but that they're quite capable. You know, a lot of them are living really great lives, and... I mean, I guess I am as well. Other than the divorce, things are going really well. And, yeah, so it's not necessarily that they need it, but maybe they feel like they need it.","Therapist: ""So you turn, right. So there's maybe a different thought, something that's already kind of perking, like, oh, it's a thing that I try to do when I have strong emotions. Right. And we can kind of wonder, is that a good thing to do or bad? It's, but what you, it's a reality right now.""
Patient: ""Right.""
Therapist: ""Yeah. But it's different than this. Yes. Okay. One final question before we try to kind of redo that whole thing. If you had, you know, a friend of yours, you know, you've got some good girlfriends, and one of them came to you and said, oh, Kate, I really need alcohol to function in my life. You know, what would you say to that person?""",411.91,438.31
094_040,094,40,1,"I feel a little bit better. I think I have a stronger understanding of... what I mean by this thought, this hot thought.","Therapist: ""Yeah. But it's different than this. Yes. Okay. One final question before we try to kind of redo that whole thing. If you had, you know, a friend of yours, you know, you've got some good girlfriends, and one of them came to you and said, oh, Kate, I really need alcohol to function in my life. You know, what would you say to that person?""
Patient: ""Well, I would definitely tell them that they don't, and I think that it may feel like they do, but that they're quite capable. You know, a lot of them are living really great lives, and... I mean, I guess I am as well. Other than the divorce, things are going really well. And, yeah, so it's not necessarily that they need it, but maybe they feel like they need it.""
Therapist: ""Right, right. Okay. Okay. All right, so let's... How are we doing in our conversation here? How are you feeling right now, just looking at all of this? What are you feeling?""",449.45,457.31
094_042,094,42,2,"I guess I feel a little bit more like it's not necessarily that I need alcohol to function, but that I believe that alcohol helps me function.","Therapist: ""Right, right. Okay. Okay. All right, so let's... How are we doing in our conversation here? How are you feeling right now, just looking at all of this? What are you feeling?""
Patient: ""I feel a little bit better. I think I have a stronger understanding of... what I mean by this thought, this hot thought.""
Therapist: ""Okay, what do you mean by this hot thought then?""",459.84,469.41
094_044,094,44,4,I believe alcohol helps me cope.,"Therapist: ""Okay, what do you mean by this hot thought then?""
Patient: ""I guess I feel a little bit more like it's not necessarily that I need alcohol to function, but that I believe that alcohol helps me function.""
Therapist: ""Okay, so I believe alcohol helps me cope. It feels like there's a butt on the I believe alcohol helps me cope, but...""",488.13,490.21
094_046,094,46,4,"Yeah, a little. But I just... I just don't think I can do it on my own. Okay.","Therapist: ""Okay, so I believe alcohol helps me cope. It feels like there's a butt on the I believe alcohol helps me cope, but...""
Patient: ""I believe alcohol helps me cope.""
Therapist: ""Do you agree that there's... It sort of feels like a cliffhanger there?""",494.9,504.13
094_057,094,57,3,"Yeah. I mean, it's, it's, it feels sad. It feels sad that that's where I'm at, but it also feels true.","Therapist: ""So let me say it again. I believe alcohol helps me cope, but it's not helpful. I need to learn new coping, new coping techniques.""
Patient: ""Yeah.""
Therapist: ""Yeah. So how does that thought make you feel first? Emotional?""",575.58,583.91
094_059,094,59,4,"that I believe alcohol helps me cope currently, yeah, I'm pretty high on that, probably about a 95.","Therapist: ""Yeah. So how does that thought make you feel first? Emotional?""
Patient: ""Yeah. I mean, it's, it's, it feels sad. It feels sad that that's where I'm at, but it also feels true.""
Therapist: ""Feels true. Okay. And that was kind of leads me to my next question. How much do you believe this thought one to a hundred percent?""",591.65,597.02
094_065,094,65,1,"I feel more in control. I feel like because it's the believe, I'm able to separate out from that need. Right. And I think that really affects puts me back in the driver's seat a little bit.","Therapist: ""You don't feel like, okay.""
Patient: ""Yeah.""
Therapist: ""Okay, and when we turn to this one, I believe alcohol helps me cope, but it's not helpful. I need to learn new coping. How do you feel in terms of control with that thought?""",625.5,638.66
095_003,095,3,2,how strong was that same thing yeah it was a not a pleasant experience yeah right maybe a little bit of anger okay but that would probably be more like 60 60 so quite a bit lower then yeah all right so some really strong,"Therapist: ""Okay. So what I'd like to introduce to you now is something called a thought record. And this is a tool that we use quite a lot in CBT and it helps us to identify thoughts and then in a really logical kind of planned out way, analyze them and then move through to thinking differently about them. Okay. So what we always start with in CBT, as we've talked about is a situation. And what I'm going to ask for you now is to think about a time in the past week where you found that your mood really kind of went down. And often we're kind of looking for that 30 minute window when this happened and the who, what, where, when of it. Can you think of a time? Yeah. Sitting in my room. Okay. Just laying in bed. Okay. You're sitting in your room. You're in bed. Yeah. And does it sound like you were alone? Yeah. Just sitting. Alright. And even as we're talking about it, I kind of feel the energy in the room kind of tank in your body language. Is that how you're feeling and thinking about it? Yeah, definitely. I think it was last Thursday.""
Patient: ""It was last Thursday.""
Therapist: ""All right. So, you know, we kind of even feel like here in the room, but this is what was going on last Thursday, just in your room, lying in bed, not doing hardly anything at all, just being there. Okay. And we can even draw on how we're feeling now, but the next column in this is our mood. Remember, moods are single words. How were you feeling at that time? Sad. Sad. Okay. And on a scale of 1 to 100%, how sad were you feeling? Oh, at least 90. 90. At least 90. Yeah. So 90 plus? Yeah. Okay. Anything else? Fear. Fear. Okay. And how strong was fear? Same. Same? About 90 or more? Yeah, about 90 or more. Okay. Anything else? Shame. Shame.""",139.48,161.58
095_005,095,5,2,"I don't know. I feel a little bit... I feel better, but thinking about it is anger making me feel a little bit anxious.","Therapist: ""All right. So, you know, we kind of even feel like here in the room, but this is what was going on last Thursday, just in your room, lying in bed, not doing hardly anything at all, just being there. Okay. And we can even draw on how we're feeling now, but the next column in this is our mood. Remember, moods are single words. How were you feeling at that time? Sad. Sad. Okay. And on a scale of 1 to 100%, how sad were you feeling? Oh, at least 90. 90. At least 90. Yeah. So 90 plus? Yeah. Okay. Anything else? Fear. Fear. Okay. And how strong was fear? Same. Same? About 90 or more? Yeah, about 90 or more. Okay. Anything else? Shame. Shame.""
Patient: ""how strong was that same thing yeah it was a not a pleasant experience yeah right maybe a little bit of anger okay but that would probably be more like 60 60 so quite a bit lower then yeah all right so some really strong""
Therapist: ""Difficult emotions. Sad at 90 plus, fear at 90 plus, shame at 90 plus, and a little bit of anger mixed in there. How do you feel now?""",174.21,184.32
095_007,095,7,4,"What were you thinking? I don't know. It was a very strong I guess if I had to put words to it, this is hopeless. This is hopeless.","Therapist: ""Difficult emotions. Sad at 90 plus, fear at 90 plus, shame at 90 plus, and a little bit of anger mixed in there. How do you feel now?""
Patient: ""I don't know. I feel a little bit... I feel better, but thinking about it is anger making me feel a little bit anxious.""
Therapist: ""Oh, you named anxious. Yeah. Was that a part of this last? Yeah, I consider that fear. Okay, the fear. Yeah. Alright. Okay. Well, let's kind of keep moving this forward. I know the emotion is kind of hard right now, but the idea is to move through this and we'll find something on the other side of it. Thinking back to this time where you're sitting in your room alone and these emotions are so strong, what were the thoughts or images going through your mind?""",216.01,229.61
095_013,095,13,2,"I'm just, I guess I'm just realizing that I guess you could connect the thought with the emotion. Sure. So, hopeless, is that why I was sad? Because I'm saying that? What do you think? Yeah, it makes sense. It makes sense, doesn't it? Yeah. But at the time, it just was like a feeling.","Therapist: ""Alright, useless.""
Therapist: ""Life's not fair.""
Therapist: ""Wow, and you can kind of see the links that this tool helps us make where strong emotions would be really linked with strong thoughts like this. This is hopeless. What's the point? Things will never change. I'm useless. Life's not fair. It didn't used to be like this. Seems to make some links between the two columns here, the mood column and the thought column. Yeah. What are you noticing here about those links?""",313.87,334.91
095_015,095,15,4,"Yeah, I didn't know.","Therapist: ""Wow, and you can kind of see the links that this tool helps us make where strong emotions would be really linked with strong thoughts like this. This is hopeless. What's the point? Things will never change. I'm useless. Life's not fair. It didn't used to be like this. Seems to make some links between the two columns here, the mood column and the thought column. Yeah. What are you noticing here about those links?""
Patient: ""I'm just, I guess I'm just realizing that I guess you could connect the thought with the emotion. Sure. So, hopeless, is that why I was sad? Because I'm saying that? What do you think? Yeah, it makes sense. It makes sense, doesn't it? Yeah. But at the time, it just was like a feeling.""
Therapist: ""Sure. You know?""",336.27,338.79
096a_003,096,3,1,"I'm fine, thank you. Good, yeah.","Therapist: ""Okay, Ali, welcome back to our session today.""
Patient: ""Hi.""
Therapist: ""Hi, how are you doing today?""",6.92,9.93
096a_005,096,5,2,"Well, yeah, I want to talk specifically about a situation that I had with a friend.","Therapist: ""Hi, how are you doing today?""
Patient: ""I'm fine, thank you. Good, yeah.""
Therapist: ""Have you gotten up to anything interesting today or this week?""",13.03,18.58
096a_007,096,7,2,"A little bit better. A little bit better. A little bit better, but when I start thinking about all my negative stuff, it brings me a little bit down.","Therapist: ""Have you gotten up to anything interesting today or this week?""
Patient: ""Well, yeah, I want to talk specifically about a situation that I had with a friend.""
Therapist: ""Okay, that sounds great. So I'm just going to put a pin in that for a sec. We'll put that on our agenda. Before that, let's just do a bit of a check-in. Would you say that your mood today, I know we're working on some depression and anxiety, some lower mood. Would you say that your mood is about the same as last week, better or worse than last week?""",38.3,47.07
096a_009,096,9,2,"I think that with the homework like realizing the cognitive distortions that I was able to understand that I'm seeing everything very negative okay yeah so you're kind of seeing that as something you that happens for you quite often yeah yeah and what does that what kind of what does that mean for you or how are you then why does that make you feel better Well, you talked last session about seeing everything through the dark lenses and remove those lenses. So I have been trying to remove and say, okay, Probably I'm being very negative and try to switch it slowly.","Therapist: ""Okay, that sounds great. So I'm just going to put a pin in that for a sec. We'll put that on our agenda. Before that, let's just do a bit of a check-in. Would you say that your mood today, I know we're working on some depression and anxiety, some lower mood. Would you say that your mood is about the same as last week, better or worse than last week?""
Patient: ""A little bit better. A little bit better. A little bit better, but when I start thinking about all my negative stuff, it brings me a little bit down.""
Therapist: ""Yeah, well, and that makes sense, doesn't it, given we've talked about the link between our thoughts and our moods. Yeah. And so when we start thinking about that negative stuff, it starts pulling us down. But I'm actually curious about, you said, and I wrote down here, that you're feeling a little bit better. What do you think is happening in your life that's bringing you to feel a little bit better?""",66.58,106.44
096a_011,096,11,2,"I learned that, as I said, I'm seeing everything very negative, but I play a lot with I should.","Therapist: ""Yeah, well, and that makes sense, doesn't it, given we've talked about the link between our thoughts and our moods. Yeah. And so when we start thinking about that negative stuff, it starts pulling us down. But I'm actually curious about, you said, and I wrote down here, that you're feeling a little bit better. What do you think is happening in your life that's bringing you to feel a little bit better?""
Patient: ""I think that with the homework like realizing the cognitive distortions that I was able to understand that I'm seeing everything very negative okay yeah so you're kind of seeing that as something you that happens for you quite often yeah yeah and what does that what kind of what does that mean for you or how are you then why does that make you feel better Well, you talked last session about seeing everything through the dark lenses and remove those lenses. So I have been trying to remove and say, okay, Probably I'm being very negative and try to switch it slowly.""
Therapist: ""That's fantastic. So interesting that we were talking about this link between our thoughts and our moods and that you really have felt when we're thinking about the negative stuff, obviously our mood goes down and you've been working at trying to look at more positive things and your mood is going up. That's really interesting and great. Okay. And thanks for bringing up the homework. Last week, you and I decided that you were going to kind of pay attention to your cognitive distortions and kind of track them. What did you learn?""",136.72,143.19
096a_013,096,13,4,but still you are depressed or you are anxious.,"Therapist: ""That's fantastic. So interesting that we were talking about this link between our thoughts and our moods and that you really have felt when we're thinking about the negative stuff, obviously our mood goes down and you've been working at trying to look at more positive things and your mood is going up. That's really interesting and great. Okay. And thanks for bringing up the homework. Last week, you and I decided that you were going to kind of pay attention to your cognitive distortions and kind of track them. What did you learn?""
Patient: ""I learned that, as I said, I'm seeing everything very negative, but I play a lot with I should.""
Therapist: ""I should. Okay. to be careful not to shit all over yourself right so okay wonderful that you're noticing not wonderful that you're doing this but good that you're noticing you're doing a lot of shoots how do you think noticing that plays into your mood i think that put out it puts a lot of pressure because then you should to be like you should be perfect you should not be depressed you should not feel anxious""",175.03,178.63
096a_015,096,15,2,"Well, I have this friend that he always checks on me. Okay. And I notice, like, I push him away.","Therapist: ""I should. Okay. to be careful not to shit all over yourself right so okay wonderful that you're noticing not wonderful that you're doing this but good that you're noticing you're doing a lot of shoots how do you think noticing that plays into your mood i think that put out it puts a lot of pressure because then you should to be like you should be perfect you should not be depressed you should not feel anxious""
Patient: ""but still you are depressed or you are anxious.""
Therapist: ""Right, yeah. So I like the way you talked about that as those pressure words, right? The shoulds, the oughts, the musts. Yeah. When we find ourselves doing that a lot, as I talked about last time, that's a real opportunity for you to breathe and take a step back from that negative thinking and think, is there something that I can think that's more positive or helpful for me in this way? Yeah. That's great. Okay, good. Well, you'd already said that you wanted to talk about a specific item. So we've done our little check-in here and getting a sense of how the week was. Let's move to agenda setting. Okay. What is it that you'd like to talk about today?""",217.87,227.25
096a_017,096,17,4,"I'm like, the first thing I think is like, I don't care. Like, he's fine. I don't want to bother him. And I'm like, I shouldn't be bothering him. So there's the issue.","Therapist: ""Right, yeah. So I like the way you talked about that as those pressure words, right? The shoulds, the oughts, the musts. Yeah. When we find ourselves doing that a lot, as I talked about last time, that's a real opportunity for you to breathe and take a step back from that negative thinking and think, is there something that I can think that's more positive or helpful for me in this way? Yeah. That's great. Okay, good. Well, you'd already said that you wanted to talk about a specific item. So we've done our little check-in here and getting a sense of how the week was. Let's move to agenda setting. Okay. What is it that you'd like to talk about today?""
Patient: ""Well, I have this friend that he always checks on me. Okay. And I notice, like, I push him away.""
Therapist: ""hmm okay yeah all right so that's what you'd like to explore a little bit today yeah yeah okay all right okay and maybe just even before we jump into that agenda item when you notice that you push him away what happens with your emotions or happens in your body um""",249.96,266.13
096a_019,096,19,2,And sometimes I feel a little bit dumb when I'm thinking this way.,"Therapist: ""hmm okay yeah all right so that's what you'd like to explore a little bit today yeah yeah okay all right okay and maybe just even before we jump into that agenda item when you notice that you push him away what happens with your emotions or happens in your body um""
Patient: ""I'm like, the first thing I think is like, I don't care. Like, he's fine. I don't want to bother him. And I'm like, I shouldn't be bothering him. So there's the issue.""
Therapist: ""There it is already. Yeah.""",268.66,274.12
096a_025,096,25,1,"Yeah, because I really want to focus on that.","Therapist: ""Okay, great. So we'll do the thought record, okay. And generally, Ali, that does take up, when I show clients this, it takes up the bulk of the session. Is it okay that this is sort of our one thing today, or is there anything else that you really wanted to make sure we get to?""
Patient: ""No, I think that will do.""
Therapist: ""That'll be okay.""",344.57,346.65
096a_027,096,27,4,"Well, he phoned me to check in on me yesterday.","Therapist: ""That'll be okay.""
Patient: ""Yeah, because I really want to focus on that.""
Therapist: ""Okay, excellent. Good. So great. So that's our agenda then for today. Why don't we move into that? And I'll show you this thought record on my trusty old whiteboard here. And then afterwards, we can kind of talk about how you want to use this in your own life. But for now, I'll show you up here, and we'll go forward from there, okay? Okay. So let me just arrange things a little bit here so I can be here by the whiteboard. So some of the headings that you'll see here are very similar to what we've used before in the past with our five-factor model, okay? Okay. So the first thing that we're going to want to look for is a situation, and I just abbreviate it here with sit. So can you think Ali about the last time when you found yourself kind of pushing this friend away and you were feeling these emotions kind of down and say, I don't care about him and pushing him away.""",401.23,405.63
096a_029,096,29,2,"And he, he said that he wanted to talk about some stuff that happened to him as well. Um, but I was like, no.","Therapist: ""Okay, excellent. Good. So great. So that's our agenda then for today. Why don't we move into that? And I'll show you this thought record on my trusty old whiteboard here. And then afterwards, we can kind of talk about how you want to use this in your own life. But for now, I'll show you up here, and we'll go forward from there, okay? Okay. So let me just arrange things a little bit here so I can be here by the whiteboard. So some of the headings that you'll see here are very similar to what we've used before in the past with our five-factor model, okay? Okay. So the first thing that we're going to want to look for is a situation, and I just abbreviate it here with sit. So can you think Ali about the last time when you found yourself kind of pushing this friend away and you were feeling these emotions kind of down and say, I don't care about him and pushing him away.""
Patient: ""Well, he phoned me to check in on me yesterday.""
Therapist: ""Okay.""",407.05,417.0
096a_031,096,31,2,"checking in on me and wanting to know how am I doing? I was like, no, I'm not ready.","Therapist: ""Okay.""
Patient: ""And he, he said that he wanted to talk about some stuff that happened to him as well. Um, but I was like, no.""
Therapist: ""Okay. good okay so remember when we're doing this is great very good so with the situation we think about the who the what the where and the when and so we're really off to the races here so yesterday your friend phoned and he just sort of wanted to check in yeah yeah okay so check in and really what we're looking for with these situations is trying to sort of think about doesn't have to be 30 minutes but we try to kind of imagine it contained to about 30 minutes or so so did this sort of feeling of no i don't want to did it show up right at the beginning of the conversation near the end in the middle how did that show up or at what point in the middle of the conversation because first he was talking about gathering together have coffee and i was kind of okay with that but when he started talking about""",472.88,480.02
096a_033,096,33,2,"I think that if he told me he needed me, I I'll be fine with that.","Therapist: ""Okay. good okay so remember when we're doing this is great very good so with the situation we think about the who the what the where and the when and so we're really off to the races here so yesterday your friend phoned and he just sort of wanted to check in yeah yeah okay so check in and really what we're looking for with these situations is trying to sort of think about doesn't have to be 30 minutes but we try to kind of imagine it contained to about 30 minutes or so so did this sort of feeling of no i don't want to did it show up right at the beginning of the conversation near the end in the middle how did that show up or at what point in the middle of the conversation because first he was talking about gathering together have coffee and i was kind of okay with that but when he started talking about""
Patient: ""checking in on me and wanting to know how am I doing? I was like, no, I'm not ready.""
Therapist: ""That was sort of the feeling where, yeah, I'm not ready. Yeah. So middle of the conversation was okay. But when he started to ask you about yourself, that's when you sort of felt not ready.""",492.08,497.73
096a_041,096,41,2,"And then, at the end, I was sad.","Therapist: ""Anxiety, okay.""
Patient: ""Fear.""
Therapist: ""And fear, okay.""",614.85,619.36
096a_043,096,43,4,"I think like 40, 40.","Therapist: ""And fear, okay.""
Patient: ""And then, at the end, I was sad.""
Therapist: ""Sadness, okay, all right. And just for us to really understand the emotions here, let's put some numbers to them as we've done before. We'll rate them. So on a scale of one to a hundred percent, a hundred percent being the most anxious you've ever been and zero meaning, well, you probably unconscious, but you know, no anxiety at all. How anxious would you say you were feeling again, back in that moment when he started asking you about.""",644.12,647.4
096a_047,096,47,2,"Yeah. Sadness showed up at the end, but I think 60 as well.","Therapist: ""Okay. 40%. Okay. Same thing with fear on its own scale of one to a hundred percent. How strong?""
Patient: ""I think 60.""
Therapist: ""60. Okay. And you said sadness showed up at the end.""",661.79,667.81
096a_051,096,51,2,That I shouldn't be bothering him.,"Therapist: ""60 as well. Okay. So really anxiety was sort of the lowest. And then fear and sadness were the two higher ones that showed up for you. Does that make sense? You know, we're kind of the, one of the real pros of these exercises is the logic that comes. Does this sort of make sense if you think about the situation and how you were feeling? Yeah. Okay.""
Patient: ""Yeah, I think so.""
Therapist: ""Okay, good. And I will ask you about how that makes sense by looking at our thoughts. Okay. That's our next column here. Thoughts and images. Thoughts and images. So when you think about, you can either, well, let's go with what makes sense. What were the thoughts that were going through your mind that were feeding into or the voices of the fear and the sadness here? What were the thoughts that were connected to those?""",722.76,725.57
096a_053,096,53,4,"What else? Um, that I feel alone.","Therapist: ""Okay, good. And I will ask you about how that makes sense by looking at our thoughts. Okay. That's our next column here. Thoughts and images. Thoughts and images. So when you think about, you can either, well, let's go with what makes sense. What were the thoughts that were going through your mind that were feeding into or the voices of the fear and the sadness here? What were the thoughts that were connected to those?""
Patient: ""That I shouldn't be bothering him.""
Therapist: ""I shouldn't be bothering him. Okay, there's good old should. Shouldn't be bothering him. Okay.""",738.19,742.38
096a_057,096,57,4,"That I don't know because, um, I don't think I am alone because I have people reaching out to me. Okay. But I think that I am pushing them away. Okay.","Therapist: ""Okay. I feel alone.""
Patient: ""Yeah.""
Therapist: ""Okay. Those are two different thoughts. Which one feels more, has more kind of energy behind it for you. I feel alone or I am alone.""",754.64,765.93
096a_059,096,59,2,Yeah.,"Therapist: ""Okay. Those are two different thoughts. Which one feels more, has more kind of energy behind it for you. I feel alone or I am alone.""
Patient: ""That I don't know because, um, I don't think I am alone because I have people reaching out to me. Okay. But I think that I am pushing them away. Okay.""
Therapist: ""Okay. So there's some other, there's some other stuff that's that you just added there. So let's just sort of capture everything. So let's put them both up here. We've got the room. I feel alone, bit of a difference. I am alone. And then I push people away.""",784.59,789.38
096a_061,096,61,2,"It is an issue because then I feel alone, but I don't want to bother anyone.","Therapist: ""Okay. So there's some other, there's some other stuff that's that you just added there. So let's just sort of capture everything. So let's put them both up here. We've got the room. I feel alone, bit of a difference. I am alone. And then I push people away.""
Patient: ""Yeah.""
Therapist: ""Now, Remember, we're always kind of looking for meaning, trying to understand what's going on behind thoughts. And especially when we have thoughts that are kind of factual. And I guess we could look at that being a fact, but this sort of sounds like something that you do feel. What's the problem with the fact that you push people away or that that's on your mind? Why is that an issue for you?""",819.15,826.06
096a_065,096,65,2,"Good question. If I bother them, then they won't be my friends anymore.","Therapist: ""I don't want to bother people.""
Patient: ""Yeah.""
Therapist: ""What would it mean about you, Allie, if you bothered somebody?""",839.62,847.86
096a_071,096,71,4,That you're not nice to be around.,"Therapist: ""Okay. So others will leave me?""
Patient: ""Yeah.""
Therapist: ""Okay. And does it have any meaning for you? If you bother someone or, you know, put them out a little bit, does that have any reflection on you or who you are as a person? What does that sound like in your mind?""",877.0,880.11
096a_073,096,73,2,Sad. You're feeling sad? Yeah.,"Therapist: ""Okay. And does it have any meaning for you? If you bother someone or, you know, put them out a little bit, does that have any reflection on you or who you are as a person? What does that sound like in your mind?""
Patient: ""That you're not nice to be around.""
Therapist: ""Not nice to be around, okay. How are you doing right now as we sort of start mapping this all out? How are you feeling in this moment?""",894.52,897.35
096a_075,096,75,2,"I think that If I'm not nice to be around, then I guess that's the main reason I'm pushing away people.","Therapist: ""Not nice to be around, okay. How are you doing right now as we sort of start mapping this all out? How are you feeling in this moment?""
Patient: ""Sad. You're feeling sad? Yeah.""
Therapist: ""Can you help me understand what's behind the sadness?""",901.67,912.83
096a_083,096,83,4,"Because I think when people ask you, how are you? And you said bad, like feeling upset and I have been very depressed. Yeah. People is not ready to hear that. So the stop sign goes both ways. Stop and don't say it to me and stop for you to don't ask.","Therapist: ""Right? And then... This is something both you and I kind of felt in our bodies when we were thinking about this here, that there was this stop sign. Is that an image that comes in your head too, this image of a stop sign?""
Patient: ""Yeah.""
Therapist: ""Yeah, okay. Yeah. And can you just reflect a little bit, Ali, why do you suppose the image of a stop sign comes up for you? Why was he starting to, why do you suppose this came up for you?""",990.63,1013.7
096a_087,096,87,1,"No, I think we're good.","Therapist: ""Right. I see. So you don't ask and I'm not going to tell. Yeah. Yeah. Okay. All right. So that stop sign comes up to both ways we'll say.""
Patient: ""Yeah.""
Therapist: ""Okay. lower down I get okay so from here just take a moment to read over our thoughts again I can help you with that with my terrible writing I should not I shouldn't be bothering him I feel alone I am alone I push people away I don't want to bother very similar others will leave me I'm not nice to be around and this image of a stop sign that goes both ways I don't want to talk about it you don't want to hear it Yeah. Anything that we've missed? Do you think anything in your mind that, oh, I want that up there or we should think about this?""",1066.66,1068.84
096a_089,096,89,2,Like something quick that happens.,"Therapist: ""Okay. lower down I get okay so from here just take a moment to read over our thoughts again I can help you with that with my terrible writing I should not I shouldn't be bothering him I feel alone I am alone I push people away I don't want to bother very similar others will leave me I'm not nice to be around and this image of a stop sign that goes both ways I don't want to talk about it you don't want to hear it Yeah. Anything that we've missed? Do you think anything in your mind that, oh, I want that up there or we should think about this?""
Patient: ""No, I think we're good.""
Therapist: ""Okay. Okay. So now we turn our attention to finding the hot thought. And when I say the word hot thought, what comes to mind for you?""",1079.81,1082.39
096a_096,096,96,2,"Um, I should. Okay.","Therapist: ""This one, I don't want to bother him or I shouldn't bother him.""
Patient: ""Yeah.""
Therapist: ""Which one do you think would be better to look at?""",1159.97,1162.2
096a_100,096,100,1,"Well, it's on TV. It's on TV. They check the evidence. Right. And then there's a trial.","Therapist: ""All right. So what we'll do now is we'll give that a circle and that'll be the thought that we're going to work on for the rest of this exercise. And that's just a really important thing is you're doing this on your own, that even though all of these thoughts, we might need to spend time, or you might need to spend time kind of thinking about all of them. We really want to do things kind of in an organized way, one step at a time. And so identifying a hot thought and working on one thought at a time will really make this exercise the most effective for us and for you. So that's just an important kind of step in this, to name all the thoughts and then find one thought that feels really important to explore. Okay? All right. So now what we're going to do is we're going to take this thought and we're going to put it on trial. So do you know about Judge Judy?""
Patient: ""Yes.""
Therapist: ""Have you heard about Judge Judy? Yeah. Tell me what you know about Judge Judy.""",1215.84,1222.63
096b_000,096,106,2,"evidence for that's my terrible writing that says evidence for and I shouldn't be bothering him so just start kind of brainstorming Ali what is some evidence that says yes it's true you shouldn't be bothering him when as I said before when people ask you how are you and you're like well really depressed and anxious yeah and and they they are not ready to Okay, so people aren't ready, what, for the truth? Would you say that? Yeah. People aren't ready for the truth, okay? I'm gonna just try to keep it short. Not ready for truth, okay? Now, let's rate our evidence here. So is that, you know, I'll just hear from you first. What do you think? Is that a one, two, or three? Is that absolutely true for everybody? Is that... Um, for some people, you know, you've heard that and you think that you feel that does that make it a one? What do you think?","Therapist: ""Very strong personality, right? Exactly. And so sometimes she's a little mean. Between you and me, I think she can be a little rough. However, we want that same kind of forward, strong personality when we're analyzing our thoughts here. And when we're going to bring in evidence, we kind of have to imagine, you know, would Judge Judy say, that's a good piece of evidence, I'm going to take that into my courtroom and think about it? Or is that a is that a really weak piece of evidence? And I'm not gonna look at that that much, okay? So I always wish I had more space on my whiteboard here, but let's, when we think about evidence, maybe I'll just ask you to bump back just a bit so I'm not standing right over top of you and I can even adjust this a little bit. There we go, yeah, great. Yeah, maybe just come in a little. Great, so we're gonna look at evidence that supports the hot thought so evidence for and we're also going to look for evidence against that says yeah that's maybe not 100 true okay okay and what we're going to look for is we're going to look for evidence that has different levels of strength and i'm going to put this up here so one will be weak two will be medium and three will be strong on both sides. Okay. So one will be stuff like, I feel like, or I heard that or stuff that maybe only a couple of people would agree with you on. Okay, that kind of, that would be that kind of evidence. So that kind of thing might be like anecdotes or things you've heard on the street or, you know, I heard, you know, some, I was on Reddit and I read something on, on the internet. So kind of a little bit weaker.""
Patient: ""Okay.""
Therapist: ""Two is that medium strength of evidence. So maybe something like a testimonial or some expert opinion, you know, that's stronger. Um, maybe at this point there might be some statistics, maybe not, but you know, several more people would agree with you that it's true. Okay. And then three is our strongest type of evidence. So that's like the smoking gun in a murder trial. So that's, you know, statistics that's cold, hard facts, tangible items. You know, by that I mean things that, you know, you can hold on to that, you know, here's a report or here's this thing that I really know to be true. And the majority of people would agree with you. Okay. Okay. So we're going to do that. And so again, that's our evidence. And we're going to think about this thought, I shouldn't be bothering him. Okay. So let's start here.""",1392.516,1452.2060000000001
096b_004,096,110,1,I I'll take it. I think that sounds about what I'm thinking too. So some people might not be ready and some people might be ready.,"Therapist: ""I think that it makes it a two because yeah, like people is not ready, but there might be one or two person. Yeah.""
Patient: ""Yeah.""
Therapist: ""Okay.""",1464.476,1471.786
096b_006,096,112,4,"Okay. Fair enough. Good. Other evidence that would say no, or I would support this. I shouldn't be bothering him.","Therapist: ""Okay.""
Patient: ""I I'll take it. I think that sounds about what I'm thinking too. So some people might not be ready and some people might be ready.""
Therapist: ""Yeah.""",1472.786,1481.356
096b_008,096,114,2,Okay. I hear you. So listening to complaining is annoying.,"Therapist: ""Yeah.""
Patient: ""Okay. Fair enough. Good. Other evidence that would say no, or I would support this. I shouldn't be bothering him.""
Therapist: ""Um, listen, people complaining about everything is annoying.""",1489.1760000000002,1495.256
096b_010,096,116,1,okay and let's rate that what do you think one two or three almost like a three yeah yeah yeah do you think like let's just think about that a little bit is it a little bit of complaining is annoying is it constant complaining is annoying is it always annoying okay okay,"Therapist: ""Um, listen, people complaining about everything is annoying.""
Patient: ""Okay. I hear you. So listening to complaining is annoying.""
Therapist: ""Yeah.""",1502.1560000000002,1529.2060000000001
096b_012,096,118,1,"But I'll put the three down. You know, I think that you're right that there can be times when it's really annoying to hear complaining. We'll kind of explore this all together in a bit here. Okay. Other evidence that says, yes, I shouldn't be bothering him.","Therapist: ""Yeah.""
Patient: ""okay and let's rate that what do you think one two or three almost like a three yeah yeah yeah do you think like let's just think about that a little bit is it a little bit of complaining is annoying is it constant complaining is annoying is it always annoying okay okay""
Therapist: ""Well, okay.""",1530.506,1544.236
096b_016,096,122,1,"Maybe something else will pop up if we get talking. So that's fine. So we've got two pieces of evidence. Maybe people aren't, he's not ready for the truth. And listening to complaining is annoying. Yeah. And our evidence here for kind of a medium piece of evidence and a fairly strong piece of evidence over here. Okay. Okay. Let's move on to this column here. So evidence against that says that this isn't 100% true all the time. What evidence would you have that says, oh, maybe I, maybe it's okay. Or maybe I could tell him what's going on.","Therapist: ""I can't think about anything.""
Patient: ""You can't think of anything else.""
Therapist: ""Okay. Okay.""",1552.4260000000002,1584.886
096b_018,096,124,2,Okay. So friend for three years.,"Therapist: ""Okay. Okay.""
Patient: ""Maybe something else will pop up if we get talking. So that's fine. So we've got two pieces of evidence. Maybe people aren't, he's not ready for the truth. And listening to complaining is annoying. Yeah. And our evidence here for kind of a medium piece of evidence and a fairly strong piece of evidence over here. Okay. Okay. Let's move on to this column here. So evidence against that says that this isn't 100% true all the time. What evidence would you have that says, oh, maybe I, maybe it's okay. Or maybe I could tell him what's going on.""
Therapist: ""Well, he has been my friend for over three years.""",1588.566,1590.736
096b_019,096,125,2,"Okay. And is that a one, two or a three?","Patient: ""Maybe something else will pop up if we get talking. So that's fine. So we've got two pieces of evidence. Maybe people aren't, he's not ready for the truth. And listening to complaining is annoying. Yeah. And our evidence here for kind of a medium piece of evidence and a fairly strong piece of evidence over here. Okay. Okay. Let's move on to this column here. So evidence against that says that this isn't 100% true all the time. What evidence would you have that says, oh, maybe I, maybe it's okay. Or maybe I could tell him what's going on.""
Therapist: ""Well, he has been my friend for over three years.""
Patient: ""Okay. So friend for three years.""",1596.3960000000002,1599.326
096b_023,096,129,1,"Yeah. If we were to ask him, Hey friend, how long have you been friends with Ali? What would he say? The same. Three years.","Therapist: ""I think that's a three.""
Patient: ""Yeah. That's kind of a fact, isn't it?""
Therapist: ""Yeah.""",1605.796,1611.496
096b_025,096,131,1,So that's good. Okay. Let's expand on that a little bit. How does that further prove that maybe it's okay to tell him what's going on and to talk to him?,"Therapist: ""Yeah.""
Patient: ""Yeah. If we were to ask him, Hey friend, how long have you been friends with Ali? What would he say? The same. Three years.""
Therapist: ""Okay.""",1612.296,1624.886
096b_030,096,136,2,is checking in. Okay. How strong would that be?,"Patient: ""Okay, so he knows some things about you.""
Therapist: ""Yeah, I think so.""
Patient: ""He knows about you.""",1652.836,1661.006
096b_032,096,138,2,"Well, and that brings up a point I wanted to ask about. Did you call him saying, oh, listen, friend, let me tell you how crappy my day has been? Or you're saying no.","Patient: ""He knows about you.""
Patient: ""is checking in. Okay. How strong would that be?""
Therapist: ""I think a three because he's calling. There's evidence for that. Yeah.""",1667.316,1678.7060000000001
096b_034,096,140,2,So he reached out to you. Yeah. He reached out to you.,"Therapist: ""I think a three because he's calling. There's evidence for that. Yeah.""
Patient: ""Well, and that brings up a point I wanted to ask about. Did you call him saying, oh, listen, friend, let me tell you how crappy my day has been? Or you're saying no.""
Therapist: ""He reached out.""",1679.346,1682.566
096b_036,096,142,1,All right. He reached out to Ali. Okay. How strong is that evidence?,"Therapist: ""He reached out.""
Patient: ""So he reached out to you. Yeah. He reached out to you.""
Therapist: ""Yeah, I usually don't call. Okay.""",1686.3560000000002,1694.636
096b_037,096,143,2,"And you know, I'm aware that there's different people out there in the world, different types of friends. Did he reach out and ask to be like nosy, to get some gossip and dirt on you? Did he reach out because he really cares and wants to help you and support you? Why do you suppose he reached out? Why did he say he wanted to reach out to you?","Patient: ""So he reached out to you. Yeah. He reached out to you.""
Therapist: ""Yeah, I usually don't call. Okay.""
Patient: ""All right. He reached out to Ali. Okay. How strong is that evidence?""",1700.4660000000001,1722.026
096b_039,096,145,2,Okay. So he asked you to have coffee.,"Patient: ""All right. He reached out to Ali. Okay. How strong is that evidence?""
Patient: ""And you know, I'm aware that there's different people out there in the world, different types of friends. Did he reach out and ask to be like nosy, to get some gossip and dirt on you? Did he reach out because he really cares and wants to help you and support you? Why do you suppose he reached out? Why did he say he wanted to reach out to you?""
Therapist: ""He said that he wanted to have coffee. Okay. And just a gathering. We haven't seen in a long time. Okay.""",1730.586,1732.836
096b_041,096,147,1,"He asked you to have coffee. So it wasn't just a quick phone call, but hey, let's get together.","Therapist: ""He said that he wanted to have coffee. Okay. And just a gathering. We haven't seen in a long time. Okay.""
Patient: ""Okay. So he asked you to have coffee.""
Therapist: ""Yeah.""",1733.9560000000001,1742.306
096b_043,096,149,2,Hmm. And what would that be?,"Therapist: ""Yeah.""
Patient: ""He asked you to have coffee. So it wasn't just a quick phone call, but hey, let's get together.""
Therapist: ""Yeah. Yeah. Yeah. Okay.""",1745.826,1750.316
096b_045,096,151,2,"So that would be a three. Yeah. Okay. Okay. So you've been friends with him for a long time. He's reached out. He reached out to you, not just a phone call, but he asked for coffee. Okay. Um, I guess I'm just curious. First off, let me check in with you. Any other evidence coming up for you that you want to name here that would say, no, it's not 100% true that I shouldn't be bothering him?","Therapist: ""Yeah. Yeah. Yeah. Okay.""
Patient: ""Hmm. And what would that be?""
Therapist: ""Well, a three. He said, I want coffee.""",1759.6960000000001,1785.6960000000001
096b_047,096,153,1,"No. Okay. Is it okay if I ask some more questions and kind of explore this some more? I'm just really curious about these ideas that, you know, some people aren't ready and some people don't like listening to complaining. And I think, you know, these are compelling pieces of evidence, relatively strong. Is he the type of person who can handle what's going on? Can he handle hearing? Is he good at that? Does he want that from you? Or is he the kind of person who's, oh my gosh, I don't know what to do with that.","Therapist: ""Well, a three. He said, I want coffee.""
Patient: ""So that would be a three. Yeah. Okay. Okay. So you've been friends with him for a long time. He's reached out. He reached out to you, not just a phone call, but he asked for coffee. Okay. Um, I guess I'm just curious. First off, let me check in with you. Any other evidence coming up for you that you want to name here that would say, no, it's not 100% true that I shouldn't be bothering him?""
Therapist: ""No.""",1787.2160000000001,1820.336
096b_053,096,159,1,So does that mean he's got some training to help people?,"Therapist: ""Yeah. Okay. He's always helping people.""
Patient: ""He's always helping people.""
Therapist: ""Okay. Yeah.""",1831.726,1834.256
096b_059,096,165,2,"Well, and that's okay. So it's some, would it be too far to stretch to say, you know, he he's good at it or has a passion for it?","Therapist: ""He's not a counselor or anything.""
Patient: ""No. Okay. Okay.""
Therapist: ""Yeah.""",1843.986,1851.6860000000001
096b_061,096,167,1,"He has a passion, has a passion to help.","Therapist: ""Yeah.""
Patient: ""Well, and that's okay. So it's some, would it be too far to stretch to say, you know, he he's good at it or has a passion for it?""
Therapist: ""Yeah. Yeah, definitely.""",1853.766,1856.346
096b_063,096,169,1,"Okay, I'm falling behind on my reading. So he's a support worker?","Therapist: ""Yeah. Yeah, definitely.""
Patient: ""He has a passion, has a passion to help.""
Therapist: ""Yeah.""",1862.736,1865.3960000000002
096b_069,096,175,1,"A two? Okay. Yeah, we're kind of maybe guessing. Have you ever asked him, do you have a passion?","Therapist: ""Oh, three.""
Patient: ""Three. He has a passion?""
Therapist: ""I guess two.""",1873.616,1878.616
096b_071,096,177,1,"And even outside of that, you know, how would you... Do you think of him as a good friend, a safe friend, who you can share with?","Therapist: ""I guess two.""
Patient: ""A two? Okay. Yeah, we're kind of maybe guessing. Have you ever asked him, do you have a passion?""
Therapist: ""Well, we have talked and he said yes. Yeah, okay.""",1884.046,1893.496
096b_073,096,179,4,"You do? Okay. So you feel like he's a safe, good friend?","Therapist: ""Well, we have talked and he said yes. Yeah, okay.""
Patient: ""And even outside of that, you know, how would you... Do you think of him as a good friend, a safe friend, who you can share with?""
Therapist: ""Yeah, I think so.""",1894.976,1898.066
096b_075,096,181,2,"Do you have any stronger evidence that says he is a good, safe friend? Does he keep your secrets? Does he help you feel better?","Therapist: ""Yeah, I think so.""
Patient: ""You do? Okay. So you feel like he's a safe, good friend?""
Therapist: ""Yeah. Okay.""",1899.826,1905.226
096b_079,096,185,2,gossiping or anything so no gossip okay okay okay let's give these numbers so it feel he feels to you kind of at a subjective level got level that's why i'm pointing to my tummy that he's a good friend what would be the evidence how strong would that be i guess i do because i still feel that if we share,"Therapist: ""Well, yeah. He has helped me feel better in the past.""
Patient: ""Has helped in the past.""
Therapist: ""Yeah, and whatever I share with him, it wasn't like""",1918.986,1944.4160000000002
096b_081,096,187,2,Okay. So it could be that there could be more connection there. Yeah. And he's helped you in the past.,"Therapist: ""Yeah, and whatever I share with him, it wasn't like""
Patient: ""gossiping or anything so no gossip okay okay okay let's give these numbers so it feel he feels to you kind of at a subjective level got level that's why i'm pointing to my tummy that he's a good friend what would be the evidence how strong would that be i guess i do because i still feel that if we share""
Therapist: ""More time together that could increase. Yeah.""",1947.746,1953.496
096b_087,096,193,4,"The stop sign came up. Okay. So that sounds like there's something else that maybe in another session, or if we take some thought records home, you could explore that pushing away piece here. And maybe we'll get to that here, but that almost sounds like something else that's going on here. So let's take note of that and maybe put it in some, you know, for us to explore, maybe use homework or somewhere down the road here. So that pushing away, the stop sign, I'm going to just give this a little, cloud here because that seems to come up a bit okay um let's just finish this over here has helped in the past what was that a one two or three um i think uh a three a three okay and he hasn't gossiped about you in the past not that i'm aware okay so maybe sure we don't know yeah okay okay okay this is hard work isn't it we've done a lot of digging around looking at the evidence What are you seeing up at the board? How are you feeling now that we've pulled this all apart and thought about this?","Therapist: ""Um, he helped me, but I guess that I pushed him away.""
Patient: ""Okay.""
Therapist: ""Yeah. Like he was starting and then the stop sign.""",1966.676,2024.486
096b_091,096,197,1,"Shoulds, shoulds, right? And that just reminds me of one other little thing that we could do. We already have tons of evidence over here. But any time that we know that there's a cognitive distortion at play, I always like to put it in the evidence against. Because cognitive distortions, as we've talked about, aren't fair, not true, not based on a lot of fact. So I just put this here, too, as one final reminder to say this is a should. And so that, to me, too, is another compelling piece of evidence that says, yeah, this probably isn't 100% true. Does that make sense? All right. So the last, we're almost at the end of this exercise. And what we need to do now is kind of re structure, recalibrate this thought now that we've looked at the whole picture, okay? This exercise kind of requires us to take our emotional blinders off, take off the blinders of fear and sadness, and to really analyze what's going on here. And so what I like to do with this is to actually give a little bit of a template. So I'm going to, I never have enough room, as I said, so I'm going to actually do it over here for our balanced thought. We've got our hot thought here. And the little template that I like to use is it may be true that blank, just a sec, and always and and not but, it is also true that. And we'd like to take a little bit from column A and a little bit from column B because we're looking for balanced adaptive thinking. So if you look at the whole picture now and think about restructuring this thought, what would it be? What comes to mind?","Therapist: ""That there is a lot of evidence against.""
Patient: ""Yeah. Yeah. And how does that make you feel?""
Therapist: ""That I should give him an opportunity. I should again. Yeah.""",2039.6860000000001,2152.306
096b_093,096,199,2,Okay. I'm scared of bothering people. Okay. And?,"Therapist: ""That I should give him an opportunity. I should again. Yeah.""
Patient: ""Shoulds, shoulds, right? And that just reminds me of one other little thing that we could do. We already have tons of evidence over here. But any time that we know that there's a cognitive distortion at play, I always like to put it in the evidence against. Because cognitive distortions, as we've talked about, aren't fair, not true, not based on a lot of fact. So I just put this here, too, as one final reminder to say this is a should. And so that, to me, too, is another compelling piece of evidence that says, yeah, this probably isn't 100% true. Does that make sense? All right. So the last, we're almost at the end of this exercise. And what we need to do now is kind of re structure, recalibrate this thought now that we've looked at the whole picture, okay? This exercise kind of requires us to take our emotional blinders off, take off the blinders of fear and sadness, and to really analyze what's going on here. And so what I like to do with this is to actually give a little bit of a template. So I'm going to, I never have enough room, as I said, so I'm going to actually do it over here for our balanced thought. We've got our hot thought here. And the little template that I like to use is it may be true that blank, just a sec, and always and and not but, it is also true that. And we'd like to take a little bit from column A and a little bit from column B because we're looking for balanced adaptive thinking. So if you look at the whole picture now and think about restructuring this thought, what would it be? What comes to mind?""
Therapist: ""Something like, it may be true that I'm scared of bothering people.""",2158.736,2170.826
096b_095,096,201,2,"Okay. That I have good friends. And is that enough, do you think, or should we add anything else?","Therapist: ""Something like, it may be true that I'm scared of bothering people.""
Patient: ""Okay. I'm scared of bothering people. Okay. And?""
Therapist: ""It is also true that... And it is also true that I have good friends.""",2177.566,2190.0860000000002
096b_097,096,203,2,"Yeah, because there's something kind of in my mind playing in the background here that you kind of addressed there, where you say, it is also true that I have good friends that can support me, or good friends that I can reach out to. Do we want to write that down, or do you think that...","Therapist: ""It is also true that... And it is also true that I have good friends.""
Patient: ""Okay. That I have good friends. And is that enough, do you think, or should we add anything else?""
Therapist: ""I think that's enough because then if I have good friends, I can reach out to them. Okay, okay, great.""",2200.616,2214.9660000000003
096b_101,096,207,1,Okay. It is also true that I have good friends who can support me.,"Therapist: ""I resonate with the sentence of they can support me.""
Patient: ""Okay, can I write that down?""
Therapist: ""Yeah.""",2221.0060000000003,2224.676
096b_105,096,211,1,"All right. So there's our restructured thought. You'll notice it's often a little longer than the hot thought because we have to kind of qualify it. It may be true that I am scared of bothering people, and it is also true that I have good friends who can and do support me. Okay, great. Last step. If we go back up here to our emotions, and this is the thought in the driver's seat now.","Therapist: ""Yeah.""
Patient: ""That you can and do support me.""
Therapist: ""Yeah.""",2231.696,2260.0060000000003
096b_107,096,213,3,Do these numbers change at all?,"Therapist: ""Yeah.""
Patient: ""All right. So there's our restructured thought. You'll notice it's often a little longer than the hot thought because we have to kind of qualify it. It may be true that I am scared of bothering people, and it is also true that I have good friends who can and do support me. Okay, great. Last step. If we go back up here to our emotions, and this is the thought in the driver's seat now.""
Therapist: ""Okay.""",2261.7960000000003,2264.036
096b_109,096,215,1,I'm going to choose a different color here. How do they change? Let's start with anxiety. How does that change?,"Therapist: ""Okay.""
Patient: ""Do these numbers change at all?""
Therapist: ""Oh, yeah. Okay.""",2265.5060000000003,2270.206
096b_117,096,223,3,"Does any new, more positive emotions arise?","Therapist: ""I don't think sadness will be there because then I'm recognizing that I have support.""
Patient: ""It goes all the way up.""
Therapist: ""Yeah.""",2297.926,2300.056
096b_119,096,225,2,So what emotion comes there for you?,"Therapist: ""Yeah.""
Patient: ""Does any new, more positive emotions arise?""
Therapist: ""Yeah, because I can count with people.""",2304.776,2307.946
096b_121,096,227,2,"Excitement, yeah, okay. Okay, what do you think of this exercise?","Therapist: ""Yeah, because I can count with people.""
Patient: ""So what emotion comes there for you?""
Therapist: ""Excitement and happiness.""",2310.286,2314.516
096b_123,096,229,1,"Yeah. Okay. That's great. So what do you think that for, you know, we're coming to the end of our session. How do you want this to show up in your week ahead? How do you want to experiment with this challenge yourself with this in the weekend?","Therapist: ""Excitement and happiness.""
Patient: ""Excitement, yeah, okay. Okay, what do you think of this exercise?""
Therapist: ""i think it's eyes open tell me a little bit more about what you mean by eye opening i i like it because then i realize that i'm not alone yeah and i think that depression always makes me feel alone and then if i'm not alone then yeah Is it worth it to really relieve this depression?""",2339.156,2354.7960000000003
096b_129,096,235,4,So a bit of a game plan to sort of test this out.,"Therapist: ""And schedule that coffee appointment.""
Patient: ""Okay.""
Therapist: ""Wonderful.""",2362.766,2365.976
096b_131,096,237,1,"Okay. All right. That sounds really, really good. So if we were to just think about that homework, um, let's put a little bit of structure around it and maybe I'll give you the pen and paper here, just so you can write down what your, what your plan will be there. When do you think you'd want to call him and set up that homework or set up that coffee room?","Therapist: ""Wonderful.""
Patient: ""So a bit of a game plan to sort of test this out.""
Therapist: ""Yeah.""",2367.236,2388.536
096b_134,096,240,1,So you can write down there. I just like to be really concrete. Is that okay?,"Patient: ""Okay. All right. That sounds really, really good. So if we were to just think about that homework, um, let's put a little bit of structure around it and maybe I'll give you the pen and paper here, just so you can write down what your, what your plan will be there. When do you think you'd want to call him and set up that homework or set up that coffee room?""
Patient: ""You know he's free tomorrow. And do you have his number?""
Therapist: ""Yeah.""",2397.686,2401.316
096b_136,096,242,3,"It just helps to have a good plan. So call him tomorrow. And will you ask, tell me sort of what you'll do.","Therapist: ""Yeah.""
Patient: ""So you can write down there. I just like to be really concrete. Is that okay?""
Therapist: ""Yeah.""",2402.436,2409.626
096b_140,096,246,2,"Good. Um, and so what do you predict? So it's, it's more probably about the conversation that's going to happen. Right. And maybe being a little bit vulnerable with him maybe, and telling him a little bit about how you're doing. What do you think that's going to be like for you? Let's make a prediction.","Therapist: ""I will say, hey, do you have time for coffee? And I know that he will say yes.""
Patient: ""You know he'll say yes.""
Therapist: ""Good. Yeah. Okay. Excellent.""",2418.396,2437.0860000000002
096b_148,096,254,2,"Okay. So let's just write down some of these predictions too. So there's one prediction that when you start talking about yourself, your anxiety will go up.","Therapist: ""Okay. And then my guessing is that he will be very supportive.""
Patient: ""Okay.""
Therapist: ""Great. Um, yeah.""",2458.986,2466.556
096b_152,096,258,3,"And how will we, let's just, we're kind of turning this into a bit of an experiment. How will you kind of gather data or what will you pay attention to to sort of test this prediction to see if your anxiety will go up and to see if he's supportive?","Therapist: ""Yeah. And then he will be supportive.""
Patient: ""And then he'll be supportive.""
Therapist: ""Okay.""",2474.4260000000004,2489.3360000000002
096b_156,096,262,1,"Okay, okay. So maybe behind here you might want to write, you know, you'll know that by a knot in your stomach and some shakiness. Would it be at all valuable? And you can really be honest here. Do you think rating it to say like it got up to a 10 out of 10 or will that be helpful?","Therapist: ""Well, I feel that anxiety, I can feel it in my body. Like I can feel the knot in my stomach.""
Unknown: ""Okay.""
Therapist: ""and a little bit shaky.""",2500.2960000000003,2517.846
096b_158,096,264,1,"You're thinking it'll be a three. Okay. So why don't you rate that and see where it actually tops out at. Okay. And then for that second part, you think the prediction is that he'll be supportive.","Therapist: ""and a little bit shaky.""
Patient: ""Okay, okay. So maybe behind here you might want to write, you know, you'll know that by a knot in your stomach and some shakiness. Would it be at all valuable? And you can really be honest here. Do you think rating it to say like it got up to a 10 out of 10 or will that be helpful?""
Therapist: ""Yeah, because I mean, it's not having a panic attack. I guess the anxiety will be like a 30.""",2527.9260000000004,2539.236
096b_160,096,266,2,"How will you, what will you see that will let you know? Oh yeah. My friend's being supportive. How will you know that?","Therapist: ""Yeah, because I mean, it's not having a panic attack. I guess the anxiety will be like a 30.""
Patient: ""You're thinking it'll be a three. Okay. So why don't you rate that and see where it actually tops out at. Okay. And then for that second part, you think the prediction is that he'll be supportive.""
Therapist: ""Yeah.""",2539.766,2544.526
096b_162,096,268,1,"Okay. Okay. So he'll, he'll express wanting to help you and say things like I'm here for you. Yeah. Okay. So that's great. Why don't we write that down? So if he, if he says that we'll know he's being supportive. Is there anything else that you think you'll observe from him that will say that will let you know that he's being supportive?","Therapist: ""Yeah.""
Patient: ""How will you, what will you see that will let you know? Oh yeah. My friend's being supportive. How will you know that?""
Therapist: ""Um, he's a good listener. Okay. And every time he says, I'm here for you. Um, He has expressed wanting to help me.""",2557.496,2576.816
096b_166,096,272,1,"Good, great. So we've got some predictions, we've got some ways to kind of pay attention to that. Anything that might get in the way from this happening? Any obstacles?","Therapist: ""yeah usually he's very expressive yeah when he's supportive and when he's happy he will show it up okay so physically okay yeah so will it be like smiling and eye contact yeah that kind of thing okay why don't we write some of those things down so smiling eye contact""
Patient: ""kind of those active listening things.""
Therapist: ""Yeah.""",2603.6760000000004,2612.286
096b_168,096,274,1,"Yeah, that can get in our way and that's pretty common. What do you think you'll do with that obstacle? Let's write the word obstacle on there. I'll take a copy of this after so I can throw it in your file. what what will you do if your anxiety really starts to peak and you have a hard time i think remembering okay great yeah so maybe what i could do is or maybe you could take a picture of this before you leave and if your anxiety gets really high you can refer to this pic to the picture and remind yourself of all of this positive information you've got for him. Does that sound good?","Therapist: ""Yeah.""
Patient: ""Good, great. So we've got some predictions, we've got some ways to kind of pay attention to that. Anything that might get in the way from this happening? Any obstacles?""
Therapist: ""Probably that I'm too scared to reach out.""",2619.276,2656.3360000000002
096b_170,096,276,2,"So the obstacle would be, what were you going to write there?","Therapist: ""Probably that I'm too scared to reach out.""
Patient: ""Yeah, that can get in our way and that's pretty common. What do you think you'll do with that obstacle? Let's write the word obstacle on there. I'll take a copy of this after so I can throw it in your file. what what will you do if your anxiety really starts to peak and you have a hard time i think remembering okay great yeah so maybe what i could do is or maybe you could take a picture of this before you leave and if your anxiety gets really high you can refer to this pic to the picture and remind yourself of all of this positive information you've got for him. Does that sound good?""
Therapist: ""Yeah, I think that sounds good.""",2657.916,2660.396
096b_172,096,278,2,"And do you remember, you just wrote obstacle. Do you remember what the obstacle might be?","Therapist: ""Yeah, I think that sounds good.""
Patient: ""So the obstacle would be, what were you going to write there?""
Therapist: ""I'm going to write the picture, and I will know that it's... Yeah, okay.""",2666.0460000000003,2669.3860000000004
096b_174,096,280,2,"Too anxious. Okay, great. How do you feel about this experiment, about this homework?","Therapist: ""I'm going to write the picture, and I will know that it's... Yeah, okay.""
Patient: ""And do you remember, you just wrote obstacle. Do you remember what the obstacle might be?""
Therapist: ""The anxiety and not going.""",2673.166,2679.996
096b_176,096,282,2,"It will support that. That's great. Good. Do you feel scared about doing this, excited about doing this?","Therapist: ""The anxiety and not going.""
Patient: ""Too anxious. Okay, great. How do you feel about this experiment, about this homework?""
Therapist: ""I think that... If we are going to put it on evidence, it will be here.""",2688.1059999999998,2694.1059999999998
096b_178,096,284,1,"So we're at the end of our time. Can you just tell me what, you know, we've done this thought record and I'll send you some copies. This is a really important tool that we've got in cognitive therapy and we'll want to visit this over several sessions. And so this won't be the last time you see this. But do you have anything that you would say are your major takeaways from our session today?","Therapist: ""I think that... If we are going to put it on evidence, it will be here.""
Patient: ""It will support that. That's great. Good. Do you feel scared about doing this, excited about doing this?""
Therapist: ""I'm excited, but a little bit scared. More excited than scared. Okay, that's great. Good. Okay.""",2700.366,2721.276
096b_181,096,287,1,Right. That's great. Okay. And you've got this homework here to kind of try it out.,"Patient: ""So we're at the end of our time. Can you just tell me what, you know, we've done this thought record and I'll send you some copies. This is a really important tool that we've got in cognitive therapy and we'll want to visit this over several sessions. And so this won't be the last time you see this. But do you have anything that you would say are your major takeaways from our session today?""
Therapist: ""I guess the major takeaway is that I'm playing""
Therapist: ""But I guess if I review every shoot with evidence, there will be a lot of evidence again for that shoot.""",2741.986,2747.666
096b_183,096,289,1,"Put that into practice. Okay, great. Here at the end, do you have any feedback for me? What felt right about today?","Therapist: ""But I guess if I review every shoot with evidence, there will be a lot of evidence again for that shoot.""
Patient: ""Right. That's great. Okay. And you've got this homework here to kind of try it out.""
Therapist: ""Yes.""",2748.696,2755.166
096b_185,096,291,1,"Okay, good. And anything that didn't feel as right? Anything that you'd like me to do less of next time?","Therapist: ""Yes.""
Patient: ""Put that into practice. Okay, great. Here at the end, do you have any feedback for me? What felt right about today?""
Therapist: ""Like having everything on the board. Even though the writing is so sloppy. Yes.""",2764.2160000000003,2771.126
096b_187,096,293,1,"Thank you. Good. So you got your homework, and we'll see you next time. Okay. Have a great week.","Therapist: ""Like having everything on the board. Even though the writing is so sloppy. Yes.""
Patient: ""Okay, good. And anything that didn't feel as right? Anything that you'd like me to do less of next time?""
Therapist: ""No, I think it was great. Okay, good. All right.""",2774.806,2780.496