Tag: cognitive behavioral therapy

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.

Realistic Goal Setting: Why Most New Year’s Resolutions Fail (and What Actually Works)

Posted on by David Zerella, LCSW in Uncategorized

Every January, many people set New Year’s resolutions with the hope that this will be the year they finally become more disciplined, motivated, organized, emotionally regulated, physically healthier, and financially stable.

By February, most of those goals have stalled or been abandoned.

This is not because people are lazy or lack willpower. More often, resolutions fail because goal-setting is approached from an unrealistic psychological framework.

Understanding why New Year’s resolutions fail—and how behavior change actually works—can help create more sustainable and mentally healthy goals.

The Motivation Myth in Goal Setting

One of the most common beliefs behind failed resolutions is:

“I need to be motivated to start.”

Although this belief feels intuitive, it is psychologically inaccurate. From a Rational Emotive Behavior Therapy (REBT) perspective, this represents an unrealistic expectation that often leads to avoidance, frustration, and self-criticism.

Motivation is not a prerequisite for action. In most cases, motivation follows behavior, not the other way around. Research in behavioral psychology consistently shows that action precedes emotional momentum.

Waiting to feel motivated before starting is similar to waiting for confidence before engaging in the behavior that builds confidence. The sequence is reversed.

Why Unrealistic Goals Lead to Burnout

In addition to relying on motivation, many people construct goals that are overly broad or rigid:

“I’m going to completely change my life.” “I’m never doing that again.” “I’m all in or nothing.”

These all-or-nothing approaches are common cognitive distortions. While they may feel decisive, they often lead to burnout and reinforce the belief that setbacks reflect personal failure.

Sustainable behavior change tends to be incremental, repetitive, and unremarkable.

One habit.

Made manageable.

Repeated imperfectly.

This is not a lack of ambition—it is a more accurate model of how long-term change occurs.

The Problem with “New Year, New Me”

Popular self-improvement narratives often suggest that meaningful change requires becoming a different person. Clinically, this framing can undermine self-efficacy by implying that the current self is insufficient to initiate growth.

From a therapeutic perspective, progress does not require reinvention. It requires consistent effort from the existing self.

Behavior change is not an identity overhaul. It is a practice.

How Self-Defeating Thoughts Sabotage Progress

Before people disengage behaviorally, they often disengage cognitively. Self-defeating beliefs typically precede avoidance.

Common examples include:

“I need to feel motivated to start.” “I should be further along by now.” “If I can’t do it perfectly, what’s the point?”

Although these thoughts may feel true, they tend to increase psychological pressure, reduce distress tolerance, and make quitting more likely.

A Rational Alternative to Motivation-Based Change

REBT emphasizes replacing unhelpful beliefs with rational, flexible alternatives that support persistence:

“I do not need to feel motivated to act.” “I can tolerate discomfort.” “I can improve one small thing at a time.” “Effort itself has value.”

This is not positive thinking or affirmation-based work. It is cognitive restructuring grounded in behavioral principles.

Progress is built through daily effort and consistency, especially when motivation is low.

Practical, Realistic Goal Setting Strategies

For individuals seeking healthier and more effective goal setting, the following principles are supported by behavioral psychology and clinical practice:

Focus on behaviors rather than outcomes Choose one habit instead of multiple simultaneous changes Expect discomfort and plan for it rather than avoiding it Measure success by follow-through, not intensity

Less pressure.

More discipline.

Smaller steps.

This approach does not lower standards—it places them where they are psychologically sustainable.

Keywords targeted: realistic goal setting, New Year’s resolutions and mental health, motivation and behavior change, REBT therapy, behavior change psychology, self-discipline vs motivation

Accountability as a Path to Growth

Posted on by David Zerella, LCSW in Uncategorized

Human psychology exists for the purpose of survival. Much of what we do—consciously or unconsciously—stems from the instinct to protect ourselves. This can often show up in unpleasant ways such as selfishness, defensiveness, or even narcissism. This is because we cling to our sense of self, avoid shame, and fight to maintain control. When someone holds us accountable, or offers constructive feedback, it feels like a direct threat. This feedback threatens our fragile survival system.

But what if feedback isn’t a threat at all? What if it’s the very thing that helps us move closer to who we want to be?

Reframing Criticism

Most of us have been conditioned to see accountability as punitive – a consequence for getting “caught” doing something wrong. That mindset might work comfortably when it’s holding others accountable, but when the focus shifts to us, it triggers defensiveness, denial, or blame-shifting.

At its core, though, constructive feedback can be a mirror. It reflects how our actions affect others, reveals our blind spots, and increases self-awareness. Instead of viewing criticism as an attack, we can see accountability as an invitation- an opportunity to self-actualize. When we move from fear to receptiveness, feedback stops feeling like a strike against our worth and becomes a compass guiding us in a better direction.

From “Fuck You” to “Thank You”

Imagine a culture where feedback isn’t met with hostility but with gratitude. Instead of a reflexive “fuck you” when we’re challenged, we respond with “thank you.”

Thank you for helping me see what I couldn’t.

Thank you for trusting me enough to call me to corrective action.

Thank you for letting me know where you stand so I can properly adapt.

That small shift can have profound effects. It builds trust in relationships, strengthens communities, and creates workplaces and families where honesty isn’t feared but welcomed. Accountability stops being a weapon and becomes a gift when we reframe it.

Choosing Growth Over Defense

This isn’t easy. Our instinct to protect ourselves won’t disappear overnight. But each time we catch ourselves getting defensive, we have a choice: double down on pride, or lean into growth. The latter requires humility, vulnerability, and courage. Yet it also leads to freedom—the freedom that comes from knowing we don’t have to be perfect, only willing to learn.

Unconditional self acceptance is the foundation of this work. Only when we accept ourselves fully can we acknowledge our mistakes and embrace feedback without shame.

If we, collectively, begin to approach accountability this way, we will change not just our individual lives but the culture we live in. A culture less obsessed with defending the ego and more committed to becoming better, together.

So the next time someone calls you out—or calls you in—pause. Breathe. And maybe, just maybe, try saying “thank you.” This week, let’s choose one phrase as our accountability anchor. Use something like “Thank you, I’ll have to think about that.” Carry it with you. Practice using it the next time feedback comes your way.

From “Have To” to “Get To”: Practicing Gratitude in the Everyday

Posted on by David Zerella, LCSW in Uncategorized

Gratitude is elusive. We know it’s available, but in the rush of daily life it can be difficult to recognize in the moment.

There’s value in what we might call grand gratitude—the ability to appreciate life as a whole. But that big-picture perspective can fade when we’re met with the sharp edges of stress, conflict, anxiety, or depression. In those moments, sweeping gratitude for “life itself” doesn’t always feel useful.

I often ask myself: I love my life, but do I love living it? Do I love every minute of it? Of course, it’s unreasonable to expect constant joy. But it raises a deeper question—how can I improve my relationship with gratitude?

One answer lies in reframing. Instead of telling myself I have to do something, I try to remind myself I get to. I get to do the things I don’t want to do. I get to live. I get to struggle. Each unwelcome task is still an opportunity—for growth, for strength, or for building resilience.

This shift feels especially relevant on Labor Day. We celebrate the chance to rest from work, but does that mean we can’t also celebrate the work itself? In America, our relationship with productivity is often demanding, even unhealthy. Work is tied to survival, status, and identity. Yet beyond making money, work can also serve as a source of purpose. What if we allowed ourselves to appreciate both sides—the days of rest and the days of labor?

The same applies to our inner lives. Just as we “get to” work for a paycheck, we also get to work on ourselves. We may not always want to, but the opportunity is there.

This is where mindfulness enters: it’s the practice of seeing opportunities where we might otherwise see burdens. To notice that we get to live, to get to struggle, to get to engage with the fullness of our human experience. Gratitude becomes less of a grand, abstract concept and more of an active, moment-to-moment practice.

The truth is, we don’t always have control over what life gives us. But we do have control over whether we see it as a burden—or as a gift we get to carry.

If you’d like to strengthen this practice, start small this week:

  • Pick one task you usually dread. Before you begin, pause and reframe it from “I have to” into “I get to.”
  • Notice what shifts. Even if the task doesn’t become enjoyable, see if it feels lighter, more purposeful, or more connected to growth.
  • Build from there. Over time, these small reframes can accumulate into a deeper sense of everyday gratitude.

This is the kind of mindful reframing I often explore with clients—finding practical ways to cultivate resilience, reduce stress, and stay connected to purpose. If you’re interested in working on your own practice of gratitude and perspective, I’d love to connect. Together, we can turn the “have to’s” of your life into meaningful “get to’s.”

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Until next time,

David Zerella, LCSW