Category: cognitive behavioral therapy

Embrace Change: The Power of Identity in Personal Growth

Posted on by David Zerella, LCSW in anxiety, cognitive behavioral therapy, personal-growth

A pair of black and blue basketball shoes placed on a stone surface with green grass in the background.

I shared this story with someone recently who was struggling with identity, confidence, and feeling stuck. The more I thought about it, the more I realized it applies to a lot of people—personally and professionally.

Some people will remember the early days of me doing all-out sprints in Jordans. I’m lucky my knees survived.

At the time, it made perfect sense to me.

Not because they were built for running. They weren’t. It made sense because they matched who I believed I was.

Basketball was my sport. Basketball had culture. It had confidence, energy, familiarity. It was part of my history. Running, on the other hand, was something you did for conditioning. It wasn’t something I identified with. It belonged to a different type of person.

That distinction mattered more than I understood.

Because many of us do this in life.

We step into something new while trying to preserve an old identity. We say we want growth, but we bring outdated self-perceptions into new environments. We want new results while staying emotionally attached to the version of ourselves that feels familiar.

That creates friction.

Eventually, after enough feedback, my stubborn ass bought real running shoes.

Small purchase.

Big shift.

The shoes didn’t magically change my life. They didn’t make me faster overnight. They didn’t transform me into a runner.

What they did do was signal that I was ready to take this new chapter seriously.

They helped me stop relating only to who I had been and become more open to who I was becoming.

That’s an important distinction.

Real change usually starts with action. You show up. You practice. You make better choices. You build consistency.

But sustainable change often requires something deeper: a shift in identity.

You stop saying, “I’m trying to do this.”

And start saying, “This is part of who I am now.”

That applies everywhere:

The person trying to become healthier while still seeing themselves as someone who always quits. The professional stepping into leadership while still thinking like they need permission. The person rebuilding after divorce, loss, or burnout while still defining themselves by the old chapter. The entrepreneur trying to grow while still attached to the safety of playing small.

Behavior matters.

But behavior becomes more powerful when it aligns with identity.

I had already started running before I bought those shoes. But it wasn’t until I changed how I saw myself that it started to feel meaningful.

Sometimes the next level of growth isn’t more effort.

It’s updating the story you keep telling yourself.

You don’t need to start running.

You don’t need to buy new shoes.

But if you’re stuck between who you’ve been and who you want to become, remember:

You don’t have to run in Jordans.

Behavioral Activation: Acting Despite Our Feelings

Posted on by David Zerella, LCSW in anxiety, burnout, cognitive behavioral therapy

A male runner wearing a red athletic outfit and number 1950, sprinting on a dry, cracked landscape with a cloudy sky.

People often assume that “feeling better” come before doing better. We tell ourselves:

  • “I feel too anxious to go out.”
  • “I don’t feel motivated enough to exercise.”
  • “I’m too depressed (or negative) to be around others.”

Unfortunately, this approach strengthens our our negative emotions. It rarely works to wait for the emotional change to occur organically. Waiting to feel right usually means waiting indefinitely.

As much as our feelings (and thoughts) can affect our behavior; a core principle of psychology is that our behaviors can also directly affect our feelings. It’s an interactive relationship.

Behavioral activation, is a well-established psychological approach, that relies on the latter principle:

Action often precedes emotional change. We gradually increase our sense of capability as we take more action. We can rewire our perspective on the desired tasks. Instead of I can’t do this, I’m not feeling it: It’s I did this even though I wasn’t feeling it.

The Decision-Making Problem

In therapy, people frequently explain their behavior through their feelings.

  • “I didn’t go to the event because I was anxious.”
  • “I stayed in bed because I was too depressed.”
  • “I said that because I was angry.”

The reasoning feels intuitive.

But it creates a predictable cycle.

  • – Avoiding anxiety strengthens anxiety.
  • – Withdrawing from others reinforces depression.
  • – Reacting in anger escalates conflict.

When behavior is consistently organized around emotions, those emotions can grow stronger rather than weaker.

The Order of Operations

Part of the issue is what I often describe as a reversed order of operations.

Many people live according to this sequence:

Feel → Act → Think

An emotion appears.

Behavior follows quickly.

Reflection happens afterward and usually with disappointment or regret.

This pattern tends to produce impulsive decisions, avoidance, and reinforce a lack of motivation.

A more effective sequence looks different:

Stop → Think → Act → Feel

Pause.

Consider your values or long-term goals.

Decide what would be the preferred way of acting. Then do it regardless. Even if you don’t like it or feel sub-optimal, it’s allowing for your emotional state to adjust over time. The feeling does not need to change first. The behavior does.

Acting Despite How You Feel

Behavioral activation is not about ignoring emotions.

It’s about not allowing them to dictate behavior.

For example:

  • “I went to the event despite feeling anxious.”
  • “I went to the gym despite feeling unmotivated.”
  • “I didn’t react despite feeling angry.”

None of these choices guarantee an immediate improvement in mood.

But they create room for change.

Avoidance almost guarantees the feelings continue and nothing improves.

Action at least allows improvement to occur.

Why Behavior Changes Emotion

Emotions are influenced heavily by behavior and environment.

When someone withdraws, avoids, or reacts impulsively, the environment tends to confirm the original feeling.

  • Isolation reinforces depression.
  • Avoidance reinforces anxiety.
  • Conflict reinforces anger.

When behavior changes, the environment often changes as well.

New experiences create opportunities for different emotional outcomes.

Feelings Are Valid — But Not Always Useful

Acknowledging emotions is important. But it doesn’t mean feelings always win. Feeling are not always helpful for making decisions, partly because they are not always accurate.

They provide information, not necessarily direction. The feeling can be a response to a problem but it isn’t the solution.

In many situations, the most productive approach is simple:

Act according to your values, not according to your temporary emotional state. Start with identifying those values and the version of yourself you would like to be.

The positive feelings will follow.

When Behavioral Activation Helps Most

Behavioral activation is particularly helpful for:

The common theme is the same:

behavior shrinks while negative emotions expand.

Reversing that pattern is where change begins.

An Actionable Step

The next time a difficult feeling appears, pause and ask one of these questions:

“If I were feeling better, what would I do?”

“How will I feel afterwards?”

“What would success look like?”

Then try doing the behavior that most aligns with your answer.

Not because you feel like it.

But despite how you feel.

Why Insight Alone Can’t Change Your Mental Health

Posted on by David Zerella, LCSW in anxiety, cognitive behavioral therapy, psychotherapy
A 3D illustration of a human brain with mechanical gears integrated into its structure, glowing with a soft red light against a pale background.

Most of my clients have incredible insight into their mental health. Many people who attend CBT therapy for anxiety or depression already know what they’re supposed to do. They understand it intellectually but still struggle.

They know when their thoughts are irrational.

They know avoidance worsens anxiety.

They know isolation feeds depression.

And yet—nothing changes.

This gap between knowing and doing isn’t a lack of intelligence. It’s certainly not for lack of effort. It’s a misunderstanding of how psychological change actually happens.

Insight Alone Rarely Creates Change

Cognitive Behavioral Therapy (CBT) emphasizes the connection between thoughts, emotions, and behavior. Understanding your thinking patterns matters. Learning how to challenge unhelpful beliefs matters.

But insight alone rarely leads to sustainable growth.

Many people can accurately identify their cognitive distortions. They can explain why their anxiety “doesn’t make sense.” They may intellectually understand why avoidance keeps them stuck. Yet, they still feel anxious, depressed, or unmotivated. Sitting alone with your thoughts and repeatedly trying to think happy thoughts is not CBT. In fact, trying to think ourselves out of emotional distress often becomes exhausting.

Knowing what would help doesn’t automatically make it easier to do it.

Practice Over Theory

My clinical approach is grounded in Rational Emotive Behavior Therapy (REBT). This is a form of CBT that places particular emphasis on how rigid beliefs and internal demands fuel emotional distress.

From an REBT perspective, we work to replace demands (“shoulds,” “have tos,” and “musts”) with preferences. So we don’t have to do the work—we prefer to do the work, because we prefer to see progress.

But simply put, we still have to practice what we know.

Don’t just talk about it—be about it.

This applies to me as well. I can’t just preach mental health and wellness; I have to actively work at living by it. (Maybe that’s why they call it a private practice). What I practice in private tends to show up in the therapy office.

If I’m burned out, overextended, or ignoring my own limits, that doesn’t stay neatly contained outside of session. Practicing self-care isn’t just something I encourage—it’s something I actively work on. Being present, emotionally attuned, and grounded with clients requires ongoing practice, not just theoretical understanding. I am not alone, nor am I special. This is part of the human experience.

“I Give Great Advice—Just Not to Myself”

Many clients describe themselves as the wise friend—the one who gives thoughtful advice. They validate others’ emotions and see situations clearly from the outside. Yet, they struggle when it comes to their own life.

Often this happens because we:

  • Validate others’ emotions while minimizing our own
  • Apply compassion outward but demand perfection internally
  • Know what helps in theory but avoid it when it feels uncomfortable
  • Let ego convince us we “shouldn’t have to do the work”

This isn’t hypocrisy. It’s human behavior. And it reinforces the same idea: knowing is not the same as practicing.

When You Know What to Do—but Still Can’t Do It

A common frustration I hear in therapy sounds like this:

“I know I shouldn’t isolate, but when I’m depressed I don’t want to burden others.”
“I know structure or exercise would help, but I can’t get myself to start—or even get out of bed.”
“I know no one is judging me at this party, but I’m still worried I’ll look foolish.”

At this point, many people assume something is “wrong” with them. In reality, they’re encountering a very normal limitation of insight-based change.

CBT isn’t about waiting to feel better before acting. It’s about learning how to act while uncomfortable. Or, as I like to say, the beauty is in the work.

Midsteps: Acting Without Needing to Feel Ready

When anxiety or depression is present, meaningful change rarely comes from trying harder or thinking more rationally first. Instead, we focus on midsteps—small, intentional actions that are possible even when motivation is low.

For example:

You don’t go to the crowded store, but you walk to the mailbox
You don’t socialize for hours, but you step outside briefly
You don’t feel confident, but you take action anyway

These steps aren’t about eliminating discomfort. They’re about moving through it—gradually demonstrating to yourself that you can withstand it.

Experiential Knowledge Is What Changes Beliefs

In CBT and REBT, beliefs change most reliably through experience—not logic alone. While we may brainstorm cognitive reframes in session to reduce stress and anxiety, long-term growth comes from experiential learning and resilience-building.

Experiential knowledge is built by:

  • Doing difficult things while anxious
  • Acting while depressed, unmotivated, or self-critical
  • Learning firsthand that discomfort is tolerable
  • Developing resilience to frustration

Sometimes those actions feel empowering. Other times they come with sweating, self-doubt, tears, or a pit in your stomach.

It all counts.

Each experience provides evidence that:

“I can tolerate discomfort and still function. I can withstand this.”

Over time, this weakens avoidance and reshapes emotional responses—not through positive thinking, but through repeated practice.

Therapy as a Place to Practice, Not Just Understand

Therapy isn’t about convincing yourself you shouldn’t feel anxious or depressed.

It’s about learning how to act effectively while you do.

For clients seeking CBT therapy for anxiety or depression, this approach often resonates with people. It particularly appeals to those who value self-improvement. They emphasize personal responsibility and intellectually honest change.

That’s why knowing isn’t enough—and why meaningful progress comes from practice over theory.

Stop Trying to Optimize Your Life (And Why Self-Optimization Fuels Anxiety)

Posted on by David Zerella, LCSW in anxiety, burnout, cognitive behavioral therapy, perfectionism, personal-growth

There’s nothing inherently wrong with wanting to improve your life.

The problem isn’t improvement. The problem is when improvement becomes a requirement or psychological demand for self-worth. Furthermore if we must always be constantly improving we leave no room for acceptance.

Bettering yourself is great. Telling yourself your not enough isn’t okay.

When Optimization Turns Into Pressure

We are living in a culture that encourages constant optimization.

Track your sleep.

Dial in your macros.

Engineer your morning routine.

Regulate your nervous system.

Maximize your potential.

None of this is pathological on its own.

But from a cognitive-behavioral perspective, distress is rarely caused by habits themselves. It’s caused by the beliefs attached to them.

When the belief becomes:

  • “If I’m not consistent, I’m failing.”
  • “If I can’t regulate my anxiety 100%, something is wrong with me.”
  • “If I’m not maximizing my potential, I’m wasting my life.”

We’ve crossed from growth into conditional self-esteem.

And conditional self-esteem is fragile. If self-worth is earned; it can be taken away.

Perfectionism in a More Sophisticated Form

Most people misunderstand perfectionism.

It’s not simply high standards.

It’s the belief that your value depends on performance.

That belief is strongly associated with:

Optimization culture often reinforces this pattern quietly.

It suggests that if you just refine the habits enough — sleep better, eat better, regulate better, focus better — you’ll finally feel like your enough.

But if your stability depends on perfect execution, you won’t feel stable for very long. Even if you capture it on one random occasion; then what? Are you required to replicated the performance indefinitely in order to maintain your worth?

That’s self-disturbing pressure, not self-actualization.

The Psychological Mechanism

Clinically, what we often see is rigidity.

Rigidity looks like:

  • Low tolerance for deviation
  • Intolerance of uncertainty
  • Excessive self-monitoring
  • Global self-judgment after minor mistakes
  • Negative self-rating

Missing one workout becomes evidence of inadequacy.

A bad night of sleep becomes a link to some personal failure.

An anxious day becomes proof that you’re not “cured.”

The behavior isn’t the issue.

The interpretation is.

This is a core principle in CBT and REBT: emotional distress is amplified by rigid, absolutistic beliefs — not by imperfection itself.

Control Is Not the Same as Health

Many optimization strategies are attempts to reduce discomfort through control.

Control can be useful.

But when control becomes an obsessive need to avoid feeling inadequate, anxious, or uncertain, it reinforces the very vulnerability it’s trying to eliminate.

The more you try to eliminate anxiety completely, the more sensitive you become to it.

The more you try to eliminate imperfection, the less resilient you become to normal human fluctuation.

Without acceptance, self-improvement becomes anxiety with better branding.

Unconditional Self-Esteem

Healthy discipline is compatible with unconditional self-worth.

Unhealthy discipline depends on conditional self-worth.

The difference is subtle but clinically important.

Unconditional self-esteem says:

I have inherent value as a human being. I can prefer to perform well, but my value is not dependent on it.

Conditional self-worth says:

I must perform well to justify my value.

The second creates chronic internal pressure.

The first creates cognitive flexibility.

And flexibility is what predicts long-term mental health.

A More Sustainable Model

Mental health is not optimal regulation.

It is psychological flexibility.

It is the ability to:

  • Miss a workout without collapsing your identity
  • Feel anxious without interpreting it as failure
  • Be inconsistent without becoming self-condemning
  • Improve without needing improvement to feel acceptable

Fixated attempts to optimize your life are often sub-optimal for your mental health.

Because they quietly reinforce the equation:

Performance = Value.

And that equation fuels anxiety.

Final Thought

You don’t need to abandon self-improvement. You need self-acceptance while doing it.

You need to loosen your attachment to optimization.

If your self-worth is stable, improvement becomes preferential.

Preferential thinking is sustainable.

Compulsive optimization (absolute thinking) is not.

Therapy FAQs: Why Am I Not Seeing Progress?

Posted on by David Zerella, LCSW in cognitive behavioral therapy, personal-growth, psychotherapy, REFLECTION

One of the most common frustrations I hear in therapy is some version of:

“I’m doing the work… but I don’t feel like I’m making progress.”

That feeling can be discouraging. People accustomed to measuring growth may question therapy’s effectiveness. Those concerned with improvement or productivity might also doubt if therapy is working.

Not seeing growth in therapy doesn’t mean nothing is happening. More often, it means progress is showing up in ways that are slower. It can be subtler and also harder to measure than we expect.

Here are a few reasons why therapy can feel stagnant even when meaningful change is happening.

1. Change Is Slow

We live in a world of immediate gratification. When something doesn’t produce quick results, it’s easy to assume it isn’t effective.

Cognitive Behavioral Therapy isn’t fast-acting in the way people often hope for. But it is long-lasting. Real change tends to happen gradually, through repetition, practice, and consistency—not sudden insight alone.

That slowness can be frustrating, especially if you’re used to seeing effort quickly turn into outcomes.

2. Change Is Subtle

We love watching our kids grow up, but we don’t notice their growth day by day.

The same is true for our own personal growth.

Subtle progress is hard to see—even when it’s happening. When change occurs in small increments, it often only becomes visible in hindsight. That makes it easy to overlook and dismiss in the moment.

3. You’re Not Used to Looking for Progress

Many people I work with are high-demand, operating-at-maximum-efficiency types.

Your brain is used to looking for the deficit, not the progress.

By “deficit,” I mean the area short of perfection—the place where you could still improve. When your mind is trained this way, it becomes very good at spotting problems and very bad at taking inventory of wins.

We get so used to asking “What still needs work?” that we rarely pause to notice what has changed.

CBT sessions help slow this process down and intentionally identify progress—even when that progress is simply prioritizing mental health by showing up consistently to sessions.

That still counts.

4. Progress Is Not Linear

If we start plotting points of happiness or progress, it becomes clear pretty quickly that growth isn’t a straight line.

You’re not always going to feel good.

You’re not always going to be successful.

Sometimes you stub your toe.

Sometimes you get sick.

Sometimes you react to a trigger in a way you wish you hadn’t.

Those moments are just that—moments. Not the journey.

Temporary setbacks don’t erase progress. They’re part of it.

5. You’re Trying… But Are You Really Trying?

Photo by Tima Miroshnichenko on Pexels.com

Effort can be difficult to define, especially in therapy.

It’s easy to feel like you’re trying just by talking about things in session. But are you doing the work outside of therapy?

That might look like:

Journaling Taking breaks Practicing boundaries Prioritizing the right kind of self-care

Insight matters—but insight alone rarely creates change. Behavior and practice are where progress tends to take root.

6. Effort Doesn’t Equal Outcome

This part is important—and often overlooked.

Sometimes we are doing the work.

We can do the right things, and it still doesn’t mean we’ll get the desired results—at least not yet.

That doesn’t mean the effort is wasted.

Keep up the effort.

Keep noticing the effort.

Give yourself some damn credit.

And trust the process.

Final Thoughts

Therapy isn’t about constant improvement or feeling better all the time. It’s about learning how to relate differently to your thoughts, emotions, and behaviors over time.

If therapy feels slow or frustrating, that doesn’t mean it isn’t working. It may mean the changes you’re making are quieter, deeper, and still unfolding.

Those changes tend to last.

Parenting by Example: How Confidence is Modeled, Not Taught

Posted on by David Zerella, LCSW in cognitive behavioral therapy, PARENTING, REFLECTION
A close-up image of an adult hand and a child's hand touching, symbolizing connection and affection.

At this stage of my career, I primarily work with young adults and adults navigating anxiety, depression, and self-esteem. But not that long ago, I was the young, cool therapist—the one parents wanted their ADHD or ODD sons to connect with.

I still love child development. I still enjoy working with kids and adolescents.

But nothing grounds you quite like having an 11-year-old daughter and a 13-year-old stepdaughter.

I am no longer the young, cool therapist. And almost certainly not the cool guy at home. (The eye rolls out number the laughs nowadays)

And honestly? That’s probably for the best.

When Being “Cool” Stops Being the Goal

Not that I’m trying to be cool to middle schoolers. Insert generic dad joke about not having rizz. (Listen, I’m cool enough to know not to even attempt it.)

A man wearing a red cap and skateboard, dressed in casual attire, greets a group of young people with the phrase 'How do you do, fellow kids?'

What’s shifted isn’t my sense of humor—it’s my focus. Somewhere in the second decade of parenting, the question quietly changes. It’s no longer about telling them they’re awesome little achievers that can do anything they put their little minds to.

It becomes about showing them what it looks like to be proud of yourself in life.

Am I someone I’d want to become?

Am I leading by example?

The First Decade: Building Their Confidence and life. 

During the first decade of parenting, I spent a lot of energy cultivating my daughter’s self-esteem. I encouraged her and celebrated her achievements. I made sure she knew she was capable and worthy.

Lately?

She gives significantly fewer shits about what I think.

She rolls her eyes and sarcastically asks “is this another life lesson?!” She complains when I encourage her to be proud of herself. I get it. It’s dorky now. It’s parent stuff.

The Second Decade: Modeling Living a confident enjoyable life. 

What actually needs my attention now isn’t coaching her confidence—but modeling it.

That means being proud of myself.

Not “cool” (that ship sailed when I started making comments worthy of Progressive Insurance commercials).

But grounded. Intentional. Honest.

Sometimes I catch myself wondering:

Would my daughter want to live a life like mine?

Two individuals running on treadmills in a gym with large windows showing a view of the outdoors.

Leading by Example Isn’t About Control—It’s About Consistency

I hope my daughter continues to be her own independent, creative self. (Though, good or bad, she has many of my idiosyncrasies.)

My role now feels less about directing her growth and more about living in a way that demonstrates self-respect.

One of the best things we can do for the people we love is take care of ourselves. We are not do it performatively, not perfectly, but consistently.

Good parenting isn’t just being present and attentive.

It’s being able to stand behind the life you’re living.

That includes being proud of your own:

  1. Daily habits
  2. Physical health and movement
  3. Mental health and emotional regulation
  4. Relationships
  5. Interests, hobbies, and passions

Kids notice what we do far more than what we say.

A framed sign with the text 'SELF CARE ISN'T SELFISH' displayed against a pink background, accompanied by a shadow from a plant.

Modeling Matters More Than Motivating

Recently, our girls did wall sits for an absurd amount of time—because I was doing a wall-sit challenge at my gym.

No lecture required.

No motivational speech.

Just modeling.

My daughter has also been leaning into humor lately. (I like to think we’ve made her life just stressful enough to have good material, yet comfortable enough to feel secure being silly.)

She told me a story from school that stuck with me.

She wanted to leave school early. She Googled me, pulled up my website, and showed her friends my profile—where my session fees are listed.

She announced:

“Guys, I have to come up with at least a hundred dollars for my dad to come get me.”

I was proud—not because she was “flexing,” but because she was playful, confident, and comfortable sharing this tibdit with her classmates ( and now with me). She proceeded to ask her classmates if she looked like me. (She did not need confirmation—unfortunately- poor girl looks exactly like her dad.)

What that moment told me was this:

She wasn’t embarrassed by me.

She wasn’t hiding me.

She was proud.

A man in sunglasses stands with a water bottle and a towel over his shoulder, watching two children play soccer in a sunny park.

Being Someone Your Kids Can Be Proud Of Starts With You

I know 11 is still young. The next decade will likely involve plenty of eye-rolling, boundary-testing, and days where I unequivocally take the L.

But I want to give myself the best chance possible—not by being perfect, but by being someone I respect.

Because when I’m proud of how I live,

when I show up for myself,

when I take care of my mental and physical health—

I’m not just teaching her confidence.

I’m showing her what it looks like.

And hopefully, one day, she’ll be damn proud of herself too.